# Creatinine/Cystatin C Ratio as a Surrogate Marker for Sarcopenia in Hepatitis-C-Associated Liver Cirrhosis After Achieving a Sustained Virologic Response

## TL;DR

This study shows that the creatinine/cystatin C ratio can reliably detect sarcopenia in hepatitis C-related liver cirrhosis patients after successful antiviral treatment.

## Contribution

The study introduces the creatinine/cystatin C ratio as a novel, practical biomarker for sarcopenia in post-treatment hepatitis C cirrhosis patients.

## Key findings

- A CCR < 0.56 was independently associated with sarcopenia in cirrhosis patients.
- CCR demonstrated good diagnostic performance with area under the curve values of 0.761 in males and 0.801 in females.
- Higher CCR values correlated with better overall survival in these patients.

## Abstract

The creatinine/cystatin C ratio (CCR) has emerged as a simple surrogate marker for muscle mass. This study aimed to evaluate the clinical utility of CCR in identifying sarcopenia among patients with hepatitis-C-virus-related liver cirrhosis who achieved a sustained virological response following antiviral treatment. In this retrospective study, 111 patients treated at our hospital between 2017 and 2022 were assessed for sarcopenia using the Japan Society of Hepatology criteria, which includes handgrip strength (HGS) and skeletal muscle mass index (SMI) measured via computed tomography. Sarcopenia was diagnosed in 30 patients (27.9%). The median CCR was 0.78 in males and 0.55 in females. Multivariate logistic regression analysis identified CCR < 0.56 as an independent factor associated with sarcopenia. Receiver operating characteristic curve analysis demonstrated good diagnostic performance, with an area under the curve of 0.761 for males and 0.801 for females. Furthermore, overall survival was significantly higher in patients with higher CCR values (>0.65 in males and >0.54 in females). The discriminative ability of CCR was comparable to that of HGS, SMI, and the composite diagnosis of sarcopenia. These findings suggest that CCR is a practical and reliable marker for sarcopenia in this patient population.