European Working Group on Sarcopenia in Older People (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in Asians with cirrhosis

Abstract Background and Objectives Multiple definitions of sarcopenia exist and the acceptable criterion which best predicts outcome is lacking. We estimated the prevalence of sarcopenia based on four criteria and assessed their utility in predicting mortality in cirrhotics. Methods In a prospective observational study, consecutive Asian patients with cirrhosis underwent testing for handgrip strength (HGS) and estimation of skeletal muscle index (SMI) using computed tomography at the third lumbar vertebra. Sarcopenia was defined based on the Western cut-off- WC (SMI Results We included 219 patients with cirrhosis (168 males; mean age 42.6 years) with 50.2% patients having decompensation. Alcohol was the commonest etiology (33.3%). The prevalence of sarcopenia was highest with the WC (males:82.1%; females:62.7%). There was a weak concordance among all criteria {Fleiss’ kappa 0.23, 95% confidence interval (CI) 0.10-0.37}. Overall 12-month survival was 86.1% (81.1-91.3%) over a median (inter-quartile range) follow-up of 12 (6-15) months. Ascites {hazards ratio (HR):6.27(95%CI:1.6-24.1); p Conclusion A weak concordance exists amongst various diagnostic definitions of sarcopenia. Sarcopenia diagnosed by a combination of low HGS and population-specific SMI cut-off (AC) best predicts mortality.