Upper limb SMI for sarcopenia diagnosis in liver cirrhosis

Introduction. The muscle mass in sarcopenia is assessed in patients with liver cirrhosis (LC) using skeletal muscle indices (SMI) measured by dual-energy X-ray absorptiometry (DXA), the results of which are distorted due to lower limb edema. This requires the development of upper limb SMI (UL SMI) to ensure more accurate assessment of muscle mass in patients with LC and ascitice-dematous syndrome. Aim. To compare the diagnostic accuracy of standard MSI and UL SMI, and develop criteria for the reference range of UL SMI in patients with decompensated LC of various origin and sarcopenia, taking into account the lower limb edema in comparable age groups. Materials and methods. A prospective cohort study was conducted. The treatment group included patients with decompensated LC and lower limb edema of various origin; the control group included healthy volunteers matched to patients by gender and age to determine the diagnostic accuracy of the technique and calculate the criteria for the reference ranges in UP SMI. All patients underwent measurements of muscle mass by DXA. Results. A total of 59 patients were examined: 39 patients with LC and 20 healthy volunteers. Based on the results of the ROC analysis, it was determined that the cut-off values for UL SMI are 1.91 kg/m 2 for men (sensitivity = 62.5%, specificity = 85.71%) and 1.47 kg/m 2 for women (sensitivity = 86.96%, specificity = 69.23%) as compared to the cut-off values for the standard SMI of 7.78 kg/m 2 for men (sensitivity = 75% and specificity = 57.14%), and SMI of 6.05 kg/m 2 for women (sensitivity = 56.52% and specificity = 69.23%). UL SMI is a more accurate marker of sarcopenia in patients with LC and lower limb edema than the standard SMI. Conclusion. The advantages of UL SMI over classical SMI for sarcopenia diagnosis in patients with cirrhosis and lower extremity edema were demonstrated. The UL SMI criteria for the reference range in patients with decompensated LC and sarcopenia were developed.