# Evaluation of Diagnostic Tools of Sarcopenia in Chronic Liver Disease: A Cross-Sectional Observational Study

## TL;DR

This study evaluates diagnostic tools for sarcopenia in liver cirrhosis patients and finds gender-specific cut-off values for better diagnosis.

## Contribution

The study identifies Indian-specific cut-off values for handgrip strength and liver frailty index to diagnose sarcopenia in liver cirrhosis patients.

## Key findings

- Sarcopenia prevalence was 48% in liver cirrhosis patients.
- Handgrip strength and liver frailty index showed high diagnostic accuracy for sarcopenia.
- Indian-specific cut-off values are recommended to avoid overestimation.

## Abstract

Introduction

Sarcopenia is consistently recognized as a strong predictor of poor outcomes in chronic liver disease and is associated with increased mortality in patients with liver cirrhosis. There is limited data on the evaluation and diagnostic tools of sarcopenia in patients with liver cirrhosis in our study setting.

Aim

This study aims to evaluate different diagnostic tools of sarcopenia in patients with liver cirrhosis in our tertiary care center.

Materials and methods

This is a cross-sectional observational study comprising 50 patients with liver cirrhosis, with or without complications. A plain CT scan of the abdomen at the third lumbar vertebra was used to measure the cross-sectional area of the psoas muscle, which was then expressed as the psoas muscle index (PMI) in mm2/m2. The PMI values of 295 mm²/m² in women and 356 mm²/m² in men were used as cut-off values to define sarcopenia. Handgrip strength (HGS) and liver frailty index (LFI) were measured, and the cut-off values for both diagnostic modalities were determined using receiver operating characteristic (ROC) analysis.

Results

The mean age of the patients was 58.16 years, with male predominance (76%). The prevalence of sarcopenia in patients with liver cirrhosis was 24 (48%). The mean PMI value was significantly lower (p = 0.001) in patients with sarcopenia than in patients with non-sarcopenia (287.28 versus 502.4), suggesting a strong association between PMI and sarcopenia. The ROC curve analysis for HGS as a predictor of sarcopenia revealed an area under the receiver operating characteristic (AUROC) of 1.000 and 0.903, indicating strong diagnostic accuracy in female (p = 0.004) and male (p = 0.001) patients. The optimal cut-off values of HGS for predicting sarcopenia were determined to be 17.3 kg and 26.1 kg, with sensitivities (Sn) of 100% and 94.7% and specificities (Sp) of 85.7% and 63.7% for female and male patients, respectively. Similarly, the ROC curve analysis for LFI as a predictor of sarcopenia revealed an AUROC of 0.985, a cut-off value of 4.2, and a sensitivity of 91.7% and a specificity of 92.3%.

Conclusion

The prevalence of sarcopenia was 48% in patients with liver cirrhosis in our study setting. The optimal cut-off values of HGS and LFI for predicting sarcopenia were found to be 17.3 kg (women) and 26.1 kg (men) and 4.2, respectively, with a good sensitivity and specificity. Indian-specific cut-offs should be used to define sarcopenia, as Western cut-offs may lead to overestimation.