Sarcopenia Doubles Mortality Risk in Gastric Variceal Bleeding, Suggests Study

Although muscle wasting is increasingly recognized as a key prognostic marker in chronic liver disease, its specific clinical impact following gastric variceal hemorrhage in cirrhosis has remained unclear due to limited multi-center evidence. To address this clinical gap, Sagnik Biswas and colleagues from six tertiary care centers in India conducted a real-world investigation to evaluate how sarcopenia influences rebleeding, further liver decompensation, and overall survival in this high-risk population.

Therefore, the retrospective multi-center study evaluated 318 cirrhotic patients with gastric variceal hemorrhage treated endoscopically or endovascularly across six Indian hospitals between 2017 and 2023. Using baseline cross-sectional imaging to define sarcopenia via skeletal muscle index, competing risk analysis assessed subsequent rebleeding and hepatic decompensation.

Key Clinical Findings of the Study Includes:

• Predominant Etiology: The study identified metabolic dysfunction-associated steatotic liver disease as the primary cause of cirrhosis among sarcopenic patients, accounting for 62% of cases (49/79 patients).
• Elevated Rebleeding Risk: The study demonstrated that sarcopenia significantly increased recurrent variceal hemorrhage risk compared to non-sarcopenic controls (sHR, 1.62; 95% CI, 1.03–2.52; p = 0.03).
• Increased Hepatic Decompensation: The study observed that sarcopenia independently doubled further decompensation risk (sHR, 2.03; 95% CI, 1.39–2.97; p < 0.01).
• Escalated Cumulative Mortality: The study reported one-, two-, and three-year mortality probabilities of 15.3%, 24.9%, and 41.1% in sarcopenic individuals versus 9.1%, 14.9%, and 14.9% in non-sarcopenic subjects.
• Independent Prognostic Predictor: The study confirmed sarcopenia as an independent predictor of overall mortality following variceal bleeding intervention (HR, 1.98; 95% CI, 1.11–3.54; p = 0.020).

The results suggest that sarcopenia is an independent predictor of adverse clinical outcomes in cirrhosis following gastric variceal hemorrhage, driving a two-fold increase in further hepatic decompensation (sHR, 2.03; p < 0.01) and substantially higher three-year cumulative mortality (41.1% vs. 14.9%).

Thus, the study concludes that clinicians managing gastric variceal hemorrhage in cirrhosis may consider routine cross-sectional radiological assessment of muscle mass to identify high-risk patients who could benefit from closer monitoring and early multidisciplinary interventions.

Although the retrospective design across six centers represents a study limitation, future prospective research could further validate these observations and establish targeted strategies to mitigate sarcopenia-associated risks in cirrhotic patients.

Reference

Biswas, S., Mitra, S., Kumar, S. E., Aggarwal, P., Kumar, K., Gupta, S., Mehta, S., Valsan, A., Arora, U., Bharadwaj, P. K., Khare, S., Chandramohan, A., Simon, B., Eapen, A., Cecil, G. H., Bayye, R., Swaroop, S., Aggarwal, A., Agarwal, S., Chaudhary, R., Hota, F., Yadav, A., Roy, A., Goenka, M., & Shalimar. (2026). Impact of sarcopenia on clinical outcomes after endoscopic and endovascular interventions for bleeding gastric varices: A multi-center real-world study. Indian Journal of Gastroenterology.