Frailty Rather Than Sonographic Muscle Measurement Predicts Outcome in Liver Cirrhosis

BACKGROUND: Sarcopenia and frailty are frequent in patients with liver cirrhosis and are associated with morbidity and mortality. Given the limitations of computed tomography (CT) for routine assessment of muscle loss and the need for practical bedside assessment, we aimed to compare sonographic muscle thickness measurement and the Clinical Frailty Scale (CFS) for their prognostic value in patients with liver cirrhosis. METHODS: In this study, data of prospectively recruited patients with liver cirrhosis (both in- and outpatients) treated at a tertiary care centre were retrospectively analysed. Sonographic muscle thickness measurement was used to calculate the feather thigh muscle thickness index (fTMTI) and the compression thigh muscle thickness index (cTMTI). Frailty was assessed using the Clinical Frailty Scale. Patients were followed for liver transplantation or death. RESULTS: In total, 153 patients were included with a median Model for End-Stage Liver Disease (MELD) of 18 (Interquartile range (IQR) 10; 24). Ninety-five patients (62.0%) were male, and 70 patients (46%) were recruited in the outpatient setting. During the 90-day follow-up period, 71 patients (46.4%) either died or underwent liver transplantation. Outpatients had more muscle mass than inpatients and a lower CFS (fTMTI 19.1 mm/m vs. 12.1 mm/m, p < 0.001 and CFS 3 vs. 5, p < 0.001). In multivariable Cox-regression models adjusted for age and MELD score, a higher CFS remained independently associated with mortality and liver transplantation (LT) (HR 1.25 (1.14; 1.63), p < 0.001), whereas fTMTI and cTMTI were not consistently associated with a poorer prognosis (fTMTI HR 1.52 (0.68; 3.42), p = 0.300; cTMTI HR 1.01 (0.61; 1.68), p > 0.9). Subgroup analyses in men confirmed a superior prognostic value of CFS (HR 1.51 (1.17; 1.94), p = 0.001) over sonographic muscle thickness measurement (cTMTI HR 0.94 (0.84; 1.04), p = 0.200; fTMTI HR 0.93 (0.88; 1.00), p = 0.039). CONCLUSION: CFS is robustly associated with poorer prognosis in patients with liver cirrhosis and seems to be superior to sonographic muscle thickness measurement of the thigh.