Rectus femoris ultrasound identifies sarcopenia and predicts poor outcomes in patients with acute decompensation of cirrhosis

Sarcopenia is strongly associated with adverse clinical outcomes in patients with cirrhosis. However, its assessment remains infrequent in clinical practice because of the reliance on CT-based SMI measurements, which are costly, expose patients to radiation, and require specialized software. This study demonstrates that bedside ultrasound measurement of RF-CSA is a simple, accurate, and reliable alternative for assessing sarcopenia in patients with decompensated cirrhosis. RF-CSA not only correlates well with SMI, but also independently predicts sarcopenia, complications, and 90-day mortality. Its strong prognostic value underscores its potential for routine use in clinical practice. Moreover, RF-CSA assessment is easy to learn, highly reproducible across different operators, and feasible for point-of-care application. These findings support the integration of ultrasound-based muscle assessment into routine cirrhosis management, enabling early risk stratification and potentially guiding targeted interventions to improve patient outcomes.