Development of Simplified Risk Assessment Scoring System for Sarcopenia in Patients With Chronic Liver Disease

Secondary sarcopenia is frequently observed in patients with chronic liver disease (CLD), and simple and practical assessment tools in aging society are limited. This study aimed to develop a risk scoring system based on the geriatric nutritional risk index (GNRI) to identify muscle abnormalities in patients with CLD.

Retrospective analysis was carried out on 1181 Japanese patients with CLD (median age 70 years; male:female = 748:433 and Child-Pugh A:B:C = 1029:129:23). LC was noted in 684. Handgrip strength decline (HGSD) and muscle volume loss (MVL) were evaluated using cutoffs established by the Japan Society of Hepatology.

The proposed scoring system (SDGS-L) was developed using logistic analysis. Factors included abnormal GNRI (< 98) (odds ratio [OR] 4.69), elderly (65-74 years and OR 2.62), late-stage elderly (≥ 75 years and OR 6.34), and female gender (OR 2.16), with points assigned based on OR values: 1 point for OR ≦ 3 and 2 points for OR > 3. Sarcopenia/HGSD/MVL prevalence increased with risk scores: 2.3%/13.8%/7.4%, 8.3%/25.8%/19.7%, 21.2%/29.3%/19.2%, and 37.0%/28.6%/18.0% for low (score 0/1), moderate (score 2), high (score 3), and super-high (score 4/5) scores, respectively (p < 0.001). GNRI cutoffs for HGS decline and muscle volume loss were 101.5 (AUC 0.675) and 97.7 (AUC 0.742). Significant correlations of GNRI with HGS and skeletal muscle index (SMI) were observed in males (r = 0.365)/(r = 0.493) and females (r = 0.297)/(r = 0.462) (each p < 0.001).

The SDGS-L scoring system provides a simple cost-effective tool for predicting sarcopenia and muscle abnormalities in patients with CLD, enabling early intervention without specialized equipment.