Sarcopenia and liver cirrhosis – Comparison of the European Working group on Sarcopenia criteria 2010 and 2019

Background and aims Sarcopenia is prevalent in 30-70 % of cirrhotic patients with a higher prevalence in men (61.6 %) than in woman (36 %). However, criteria for the diagnosis of sarcopenia are not universally accepted and several different definitions coexist. In 2010, The European Working Group on Sarcopenia in Older People (EWGSOP) provided consensus criteria for the diagnosis of sarcopenia using muscle mass, strength and performance as a clinical definition. In 2019, a revised definition was published. It is yet unclear how these modified criteria influence the rate of diagnosis in high risk populations, such as liver cirrhosis.

Method We therefore assessed if the new diagnostic criteria for sarcopenia impact on sarcopenia prevalence in liver cirrhosis. Within 2 years 114 cirrhotic patients were prospectively enrolled in the study. Sarcopenia was determined by muscle strength (handgrip strength), muscle mass (lumbal muscle index) and muscle performance (gait speed). We assessed the absence of sarcopenia or the presence of pre-sarcopenia or sarcopenia using both 2010 and 2019 definitions.

Results Based on the 2010 definition, 38/114 (33.3 %) patients had no sarcopenia, 35/114 (30.7 %) suffered from pre-sarcopenia and 41/114 (36 %) from sarcopenia. With the 2019 definition, significantly more patients 91/114 (79.8 %) were diagnosed as non-sarcopenic, whereas only 4/114 (3.5 %) were diagnosed as pre-sarcopenia and 19/114 (16.7 %) as sarcopenic (p <  0.0001). Indeed, when applying the 2010 definition, significantly more men were diagnosed as pre-sarcopenic (80 % of 35, p = 0.042) and sarcopenic (87.8 % of 41, p = 0.003) compared to the non-sarcopenic group. Using the 2019 definition, the rate of pre-sarcopenia was significantly lower (30.7 % vs. 3.5 %) due to the different starting points (2010 muscle mass, 2019 muscle strength) and cut-off values for muscle strength (Sankey diagram).

Conclusion The change in diagnostic criteria for sarcopenia drastically influences the rate of pre-sarcopenia and sarcopenia diagnosed cirrhotics. To evaluate, which diagnostic criteria should be chosen to diagnose sarcopenia in liver cirrhosis patients, prospective studies are needed.

Figure 2 Sankey diagram to visualize and quantify the changes in sarcopenia diagnosis.

Publication History

Article published online:
16 June 2020