Cachexia is an independent predictor of mortality in patients with cirrhosis

Cachexia is a systemic response syndrome characterized by disabling wasting during disease progression. This study aimed to elucidate factors associated with cachexia in patients with cirrhosis and to examine the impact of cachexia on patient survival.

This multicenter retrospective cohort study included patients with cirrhosis admitted to two distinct institutes in Japan. Cachexia was diagnosed according to the criteria proposed by the Asian Working Group for Cachexia. Factors associated with cachexia and the prognostic impact of cachexia were assessed using logistic regression and Cox proportional hazards regression, respectively.

Of the 723 patients enrolled (median [interquartile range] age, 71 [64-77] years; 456 [63%] were male; and 390 [54%] had viral hepatitis), 200 (28%) met the criteria for cachexia diagnosis, with the prevalence increasing with Child-Pugh class from A (17%) to B (40%) and C (66%). Multivariable logistic regression analysis revealed that age and indices of liver function reserve, including Child-Pugh score, were associated with cachexia, whereas sex, etiology of cirrhosis, and complications with hepatocellular carcinoma (HCC) were not. During a median follow-up period of 3.2 years, 264 (37%) patients died. Multivariable Cox regression analyses showed that cachexia was independently associated with increased mortality (adjusted hazard ratio, 1.62; 95% confidence interval, 1.24-2.12), along with factors related to liver function, HCC, and alcohol-associated liver disease as the etiology. [Correction added on 22 May 2025, after first online publication: The adjusted hazard ratio and confidence interval in the Results section of Abstract have been changed from '1.59; 95% and 1.43-1.77' to '1.62; 95% and 1.24-2.12'.] CONCLUSIONS: Cachexia is associated with poor liver function in patients with cirrhosis and is an independent prognostic factor.