A simple score of sarcopenic obesity predicts all-cause mortality in patients with cirrhosis

To evaluate the predictors and prognostic impact of sarcopenic obesity (Sa-O) on all-cause mortality in patients with cirrhosis.

This retrospective cohort study included cirrhosis patients. Sa-O was defined using computed tomography at L3 level as a skeletal muscle index <42 cm²/m² or <38 cm²/m² in men and women, respectively, with a visceral adipose tissue area >100 cm². The primary outcome was all-cause mortality. A nomograph was developed based on identified predictors, generating the age-body mass index (BMI)-alcohol-hypertension (ABAH) score.

Among 769 cirrhosis patients (60.1% male; 45.5% aged ≥60 years; median follow-up: 4.3 [1.7-7.0] years), 129 (16.8%) were diagnosed with Sa-O. Multivariable analysis identified age (OR [odds ratio] 1.813, 95% confidence interval [CI] 1.210-2.718, p = 0.0040), BMI ≥ 28 kg/m² (OR 0.076, 95% CI 0.018-0.317, p = 0.0011), alcoholic liver disease (OR 1.685, 95% CI 1.078-2.634, p = 0.0220), and hypertension (OR 1.801, 95% CI 1.184-2.739, p = 0.0059) as independent predictors of Sa-O. As for BMI (OR 0.076), the limitations of BMI in reflecting body composition led to the counterintuitive research findings. When stratified by ABAH score into low (<100), medium (100-129), and high (≥130) score groups, patients demonstrated progressively higher rates of Sa-O (8.4, 18.7, and 30.5%, respectively; p = 0.026). The prognostic value of the ABAH score was analyzed using a Cox proportional hazards model by subgroups analysis. It showed significant prognostic value for all-cause mortality, with medium-score patients exhibiting a 1.53-fold increased risk (95% CI 1.12-2.09, p = 0.007) and high-score patients a 1.72-fold increased risk (95% CI 1.22-2.42, p = 0.002) compared to the low-score reference group.

Sa-O in patients with cirrhosis is associated with age, BMI, alcoholic liver disease, and hypertension. The newly developed ABAH score, a composite clinical risk marker, predicted the probability of Sa-O and was associated with all-cause mortality in patients with cirrhosis.