Assessment of Magnitude of Sarcopenia among Adult Patients with Liver Cirrhosis and Its Impact on Predicted Twelve-Month Mortality at a Tertiary Health Care Centre of North India

Cirrhosis is a chronic and irreversible liver disease, characterized by fibrosis and nodular regeneration, which often leads to complications such as ascites, hepatic encephalopathy, and variceal bleeding. In India, the burden of cirrhosis is on the rise, primarily due to hepatitis B and C infections, alcohol misuse, and metabolic-associated steatotic liver disease (MASLD) . These complications significantly reduce survival, with the five-year mortality rate ranging between 20% and 30%. Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and strength.  However, awareness regarding sarcopenia remains low among clinicians. In the Indian context, the under diagnosis is further aggravated by limited availability of diagnostic tools such as DEXA scan, Bioelectrical Impedance Analysis (BIA), CT, and MRI . As a result, opportunities for early diagnosis and intervention are often missed, leading to increased morbidity and mortality, prolonged hospitalization, and higher healthcare costs.

It is estimated that sarcopenia affects 45% to 70% of patients with cirrhosis in the South-East Asian region. In such patients, sarcopenia independently contributes to a two- to three-fold increase in mortality. While it is typically associated with ageing and commonly observed in individuals above 60 years of age, sarcopenia tends to appear much earlier in patients with chronic liver disease (CLD). This early onset is attributed to the catabolic and inflammatory environment caused by hepatic dysfunction, including hyperammonaemia, hormonal imbalances, malnutrition, and physical inactivity. Consequently, there is an increased risk of mortality even at a younger age.

Currently, prognostic models such as the Child-Pugh score are widely used to predict short-term mortality in patients with cirrhosis. However, these models may not adequately reflect the impact of sarcopenia . There is a paucity of Indian data regarding the prevalence of sarcopenia and its prognostic implications in liver cirrhosis. Addressing this gap is crucial, particularly in tertiary care centres where patient load is high.