Treatment of Sarcopenia Improves the Muscle Mass and Muscle Strength of Patients With Liver Cirrhosis- Child C: A Randomized Double Blind Control Trial

Globally, the mortality after any infection in cirrhosis patients is very high. The cumulative mortality in patients with infections was 43.5% (11,987 patients) where as the mortality rate without infection was 13.6% (2317 patients). Over the years, variceal bleeding causing death in cirrhosis has declined substantially but there has been no improvement in infection causing mortality over several decades. It adversely affects clinical outcomes including survival, quality of life, development of other complications.

Radiological image analysis is currently used to diagnose sarcopenia in cirrhosis. The European Working Group on Sarcopenia in Older People and Wilson D et al, recommend using the presence of both low muscle mass and low muscle function (strength or performance) for the diagnosis of sarcopenia.

Cirrhosis is believed to be a state of anabolic resistance and standard replacement of nutrients are generally ineffective.

Patients with cirrhosis frequently show protein and energy deficiency. Protein deficiency leads to hypoalbuminemia, inducing ascites and edema, whereas energy deficiency decreases fat and muscle mass and causes muscle weakness, decreasing the quality of life of patients with cirrhosis. Moreover, in patients with advanced chronic liver disease, Branched Chain Amino acids concentrations are low, whereas the concentrations of aromatic amino acids such as phenylalanine and tyrosine are high, conditions that may be closely associated with hepatic encephalopathy and the prognosis of these patients. The survival rate of patients with sarcopenia liver cirrhosis has been found to be significantly lower than that of non-sarcopenia cirrhotic patients. Long-term Branched Chain Amino acids supplementation significantly raises the survival rate in sarcopenia liver cirrhosis but not in non-sarcopenia liver cirrhosis showed that sarcopenia was associated with mortality in patients undergoing Live Donor Liver Transplantation, and perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.

It has been reported that the longer the duration on a waiting list for liver transplantation, the more sarcopenia the patient has become, even though their Model for End-stage Liver Disease scores stay the same. Patients in an advanced state of sarcopenia are confronted by their vulnerability to infection, and ultimately their imminent death. Patients with sarcopenia tended to have postoperative complications, especially infectious complications. Studies differ on the effect of of Sarcopenia on post transplant mortality. Montano-Loza et al reported that patients with "extreme" sarcopenia exhibited significantly worse prognosis. Nevertheless, patients with severe sarcopenia must have worse prognoses because of the vulnerability to infectious problems.