New Bedside Tools Identify Liver Cirrhosis Patients at High Risk for Complications: Study

India: A study published in the Indian Journal of Gastroenterology revealed that utilizing a portable ultrasound machine and a dynamometer for bedside assessment of sarcopenia effectively identifies liver cirrhosis patients who are at a high risk of complications and mortality.

Sarcopenia is linked to numerous negative outcomes in cirrhosis patients. The current tools for assessing sarcopenia have various shortcomings. The researchers investigated the effectiveness of using portable ultrasonography and a dynamometer for bedside assessment of sarcopenia and its implications in hospitalized cirrhosis patients.

Sabbu Surya Prakash, Department of Gastroenterology, All India Institute of Medical Sciences et. al. conducted a study to evaluate the bedside assessment of sarcopenia in hospitalized patients with liver cirrhosis, focusing on its magnitude and clinical implications.

In this study, a dynamometer was utilized to assess hand-grip strength (HGS), while an ultrasound was employed to measure the thickness of the forearm and quadriceps muscles. According to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, HGS values less than 27 kg for men and less than 16 kg for women were considered significant. The lower normal limit of muscle mass (5th percentile) was established based on measurements from 100 matched healthy controls.

The key findings of the research were as follows:

According to EWGSOP2 criteria and HGS values, 56% of 300 cirrhosis patients had sarcopenia, and 62.3% had probable sarcopenia.

HGS alone identified sarcopenia in 88.9% of patients but overestimated it in 6.3% of cases.

Sarcopenic patients had more cirrhosis complications, such as ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, sepsis, hepatorenal syndrome, and refractory ascites, compared to those without sarcopenia.

In-hospital mortality, three-month mortality, and six-month mortality rates were all higher among sarcopenic patients.

Cox regression survival analysis showed that six-month mortality was significantly higher in sarcopenic patients than in those without sarcopenia.

The researchers concluded that bedside assessment of sarcopenia using a portable ultrasound machine and a dynamometer detects liver cirrhosis patients with a high risk of complications and mortality.

Reference:

Prakash, S.S., Priyadarshi, R.N., Surya, H. et al. Bedside assessment of sarcopenia in hospitalized patients with liver cirrhosis: Magnitude and clinical implications. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-024-01642-x