A Cross Sectional Study for Determining Prevalence of Sarcopenia and Myosteatosis and Its Association with Imaging and Clinical Parameters in Patients with Cirrhosis

Background and Aim: Muscle disorders are characterized by decreased bulk (sarcopenia) and increased intra- and inter-muscular adiposity (myosteatosis). These are highly prevalent in cirrhotic patients (30-70%) and significantly impact the outcomes, albeit their under-recognition. We aimed to study prevalence of sarcopenia and myosteatosis in cirrhotic patients and to compare clinical assessment to that of imaging (CT-based) parameters. Methods: This was single centre, cross sectional study comprising 388 patients with liver cirrhosis. Clinical profile and anthropometric data including midarm muscle circumference (MAMC), handgrip-strength (HGS), short physical performance battery (SPPB) was measured. Sarcopenia was defined as L3 skeletal muscle index (L3SMI) <36.5 cm2/m2 (males) and <30.2 cm2/m2 (Females) as from previous Indian literature. Myosteatosis was defined as skeletal muscle radiation attenuation (SM€ RA) <41 HU for patients with BMI <25kg/m2 and <33 HU for patients with a BMI >25 kg/m2. Results: Prevalence of Sarcopenia and myosteatosis was 44.8% and 67.7% respectively. Among sarcopenic patients, 87.93% had concomitant myosteatosis. Multiple logistic regression analysis showed lower BMI (OR, 4.71; 95%CI, 2.69-8.222; p<0.0001), lower MAMC (OR, 1.95, 95%CI, 1.14-3.35; p< 0.05) and higher MELD scores (OR, 3.13; 95%CI, 1.79-5.46; p<0.0001) were significant independent factors associated with sarcopenia. Myosteatosis (OR, 2.07; 95%CI, 1.82-2.34; p<0.0001) was risk factor for sarcopenia on univariate analysis, but not multiple logistic regression analysis. Non-sarcopenic patients with myosteatosis had significantly higher mean MELD; and lower HGS, MAMC and SPPB scores as compared to non-myosteatotic non-sarcopenic patients. Sensitivity and specificity of clinical parameters in predicting muscle disorders ranged from 70 -90% and 55 -75% respectively, suggesting their limited role in early diagnosis. Conclusions: CT assessment can predict muscle disorders earlier than clinical parameters. Using myosteatosis rather than sarcopenia alone can detect more patients with muscle disorder and may help early initiation of therapy to prevent muscle-function deterioration.