Association of Hormonal Status With Sarcopenia, Frailty and Outcome in Patients With Decompensated Cirrhosis

Sarcopenia and frailty have been associated with hormonal dysregulation in non-cirrhotic populations. The aim of the study was to evaluate hypothalamic-pituitary-adrenal and gonadal (HPA-HPG) axes as well as growth hormone/insulin-like growth factor-1 (GH/IGF-1) levels in patients with cirrhosis and their correlation with reduced muscle mass and frailty.

One hundred twenty-four patients with decompensated cirrhosis were prospectively included. Clinical and laboratory variables, including hormonal assessment, were evaluated. MELD-Na and Child-Turcotte-Pugh scores were calculated. Muscle mass was estimated through mid-arm muscle circumference and dual energy X-ray absorptiometry. Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI) were also calculated.

Among the studied hormones, low DHEAS levels were the only independent factor associated with abnormal SPPB and LFI [Odds ratio (OR): 1.11, p = 0.019 and OR: 0.97, p = 0.005 respectively]. Separate analysis on the basis of gender revealed that DHEAS was independently associated with abnormal SPPB and LFI only in men. Δ4 androstenedione [Hazard Ratio (HR): 0.64, p = 0.038] and MELD-Na score (HR: 1.108, p = 0.0057) were the only prognostic factors independently associated with mortality. MELD-Na was significantly associated with the outcome in both male and female patients (HR: 1.052, p = 0.04 and HR: 1.22, p = 0.009, respectively), whereas Δ4 androstenedione was significantly associated only in men (HR: 0.47, p = 0.01).

Our study is the first to evaluate HPA-HPG and GH/IGF-1 dysregulation in the same cohort of patients with decompensated cirrhosis. DHEAS was the only hormone correlated with frailty parameters and physical function, whereas low Δ4 androstenedione was associated with adverse outcomes in men.