# A simple score of sarcopenic obesity predicts all-cause mortality in patients with cirrhosis

## TL;DR

This study shows that a new score called ABAH can predict sarcopenic obesity and all-cause mortality in cirrhosis patients.

## Contribution

The ABAH score is a novel composite clinical risk marker for predicting sarcopenic obesity and mortality in cirrhosis patients.

## Key findings

- Sarcopenic obesity was found in 16.8% of cirrhosis patients and was associated with age, BMI, alcoholic liver disease, and hypertension.
- The ABAH score effectively predicted the probability of sarcopenic obesity and was linked to increased all-cause mortality.
- Patients with higher ABAH scores had significantly higher mortality risks compared to those with lower scores.

## Abstract

To evaluate the predictors and prognostic impact of sarcopenic obesity (Sa-O) on all-cause mortality in patients with cirrhosis.

This retrospective cohort study included cirrhosis patients. Sa-O was defined using computed tomography at L3 level as a skeletal muscle index <42 cm2/m2 or <38 cm2/m2 in men and women, respectively, with a visceral adipose tissue area >100 cm2. The primary outcome was all-cause mortality. A nomograph was developed based on identified predictors, generating the age–body mass index (BMI)–alcohol–hypertension (ABAH) score.

Among 769 cirrhosis patients (60.1% male; 45.5% aged ≥60 years; median follow-up: 4.3 [1.7–7.0] years), 129 (16.8%) were diagnosed with Sa-O. Multivariable analysis identified age (OR [odds ratio] 1.813, 95% confidence interval [CI] 1.210–2.718, p = 0.0040), BMI ≥ 28 kg/m2 (OR 0.076, 95% CI 0.018–0.317, p = 0.0011), alcoholic liver disease (OR 1.685, 95% CI 1.078–2.634, p = 0.0220), and hypertension (OR 1.801, 95% CI 1.184–2.739, p = 0.0059) as independent predictors of Sa-O. As for BMI (OR 0.076), the limitations of BMI in reflecting body composition led to the counterintuitive research findings. When stratified by ABAH score into low (<100), medium (100–129), and high (≥130) score groups, patients demonstrated progressively higher rates of Sa-O (8.4, 18.7, and 30.5%, respectively; p = 0.026). The prognostic value of the ABAH score was analyzed using a Cox proportional hazards model by subgroups analysis. It showed significant prognostic value for all-cause mortality, with medium-score patients exhibiting a 1.53-fold increased risk (95% CI 1.12–2.09, p = 0.007) and high-score patients a 1.72-fold increased risk (95% CI 1.22–2.42, p = 0.002) compared to the low-score reference group.

Sa-O in patients with cirrhosis is associated with age, BMI, alcoholic liver disease, and hypertension. The newly developed ABAH score, a composite clinical risk marker, predicted the probability of Sa-O and was associated with all-cause mortality in patients with cirrhosis.