# Sarcopenia Risk Identified by Strength, Assistance With Walking, Rising From a Chair, Climbing Stairs, and Falls (SARC-F) in Patients With Cirrhosis: A Real-World Cross-Sectional Study

## TL;DR

This study shows that the SARC-F questionnaire can help identify sarcopenia risk in cirrhosis patients, who are at higher risk of complications.

## Contribution

The study evaluates the SARC-F questionnaire as a practical tool for identifying sarcopenia risk in cirrhosis patients in real-world settings.

## Key findings

- 35.6% of cirrhosis patients had high sarcopenia risk based on SARC-F scores.
- Higher SARC-F scores were linked to older age, higher MELD scores, and more frequent ascites.
- The SARC-F questionnaire is a feasible tool for identifying sarcopenia risk in routine clinical practice.

## Abstract

Introduction: Sarcopenia is highly prevalent in patients with liver cirrhosis and is associated with increased morbidity, hospitalization, and mortality. However, routine screening is not consistently performed in clinical practice. The strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire is a simple tool that may facilitate early identification of sarcopenia risk.

Methods: This cross-sectional study included adult patients with cirrhosis attending a tertiary government hospital in Bahrain between January 1, 2024, and December 31, 2025. Sarcopenia risk was assessed using the SARC-F questionnaire, with a score ≥4 indicating high risk. Clinical and laboratory data were collected. Multivariable logistic regression was used to identify independent predictors of sarcopenia risk.

Results: A total of 362 patients were included (mean age 56.8 ± 11.9 years; 221 (61.0%) males). High sarcopenia risk (SARC-F ≥4) was identified in 129 patients (35.6%). Patients with high risk were older (60.2 vs 54.9 years, p < 0.001), had higher model for end-stage liver disease (MELD) scores (14.6 vs 11.2, p < 0.001), and more frequent ascites (75 (58.1%) vs 80 (34.5%), p < 0.001). They also had higher rates of hospitalization (55 (42.6%) vs 54 (23.3%), p < 0.001). On multivariable analysis, age (adjusted odds ratio (aOR): 1.05; 95% CI: 1.02-1.07), MELD score (aOR: 1.09; 95% CI: 1.04-1.14), and ascites (aOR: 1.87; 95% CI: 1.18-2.95) were independently associated with sarcopenia risk.

Conclusions: Sarcopenia risk appears to be common among patients with cirrhosis and is associated with markers of disease severity. The SARC-F questionnaire may serve as a simple screening tool to identify patients at higher risk in routine clinical practice.