Using Serum Creatinine-to-Cystatin C Ratio to Predict Sarcopenia in Patients With Liver Cirrhosis

The creatinine-to-cystatin C ratio (CCR) is considered a convenient surrogate marker for muscle mass, although its evidence in cirrhotic populations is limited. This study investigated the significance of CCR as a marker of sarcopenia in patients with cirrhosis.

Handgrip strength (HGS) and skeletal muscle mass index (SMI) were assessed in 195 patients with cirrhosis, divided into the sarcopenia (n = 70) and nonsarcopenia (n = 125) groups. Risk factors associated with sarcopenia were identified through multivariable logistic regression analyses.

Sarcopenia was diagnosed in 70 out of 195 patients (35.9%). Patients with sarcopenia were significantly older, with lower body mass index (BMI), serum creatinine, and CCR, as well as higher albumin-bilirubin scores. Age ≥ 65 years, BMI < 25, and low CCR (< 0.63 in women, < 0.68 in men) were independently associated with sarcopenia on both univariable and multivariable analyses. The predictive accuracy of CCR for sarcopenia was comparable to that of a multivariable model combining age and BMI. On Kaplan-Meier analysis, overall survival was significantly lower in patients with low CCR (< 0.66) versus those with high CCR (≥ 0.66). Furthermore, HGS, SMI, and sarcopenia had comparable diagnostic value.

CCR is a simple, noninvasive biomarker for the diagnosis and prognosis of sarcopenia in patients with LC.