Diagnostic Performance of Serum Adiponectin and a Biomarker-Based Model for Sarcopenia in Compensated Cirrhosis

Background/Objectives: Sarcopenia is a frequent complication of cirrhosis and is associated with poor clinical outcomes. Computed tomography (CT) is the reference standard for diagnosis but is limited by cost and accessibility. This study aimed to evaluate the diagnostic performance of circulating myokines and adipokines and develop a simple clinical prediction model for sarcopenia in patients with compensated cirrhosis.

One hundred sixteen patients with compensated cirrhosis (Child-Pugh score≤8) were prospectively enrolled. Sarcopenia was defined by CT-based skeletal muscle index at the L3 level (SMI-L3<42 cm²/m² in men and <38 cm²/m² in women). Serum myostatin, follistatin, and adiponectin levels were measured using enzyme-linked immunosorbent assays. Diagnostic accuracy was compared using the area under the receiver operating characteristic (AUROC) curve and predictors of sarcopenia were identified using logistic regression modeling.

Sarcopenia was present in 32.8%. Sarcopenic individuals were older, had lower body mass index (BMI), higher liver disease severity, and reduced handgrip strength (HGS) in unadjusted comparisons. Serum adiponectin was significantly higher in sarcopenic patients (9.3 ± 3.9 vs 5.8 ± 4.0 μg/mL; P < 0.001) and showed the best discrimination (AUROC = 0.76), outperforming follistatin (0.67), myostatin (0.63), low HGS (0.53), and low SMI by bioelectrical impedance analysis (0.62, all P < 0.05). A multivariable model incorporating adiponectin, BMI, and age further improved the diagnostic performance (AUROC = 0.87; P = 0.005) with good calibration (Hosmer-Lemeshow P = 0.31).

Serum adiponectin is a promising noninvasive biomarker for sarcopenia in patients with compensated cirrhosis. A model integrating adiponectin, BMI, and age significantly enhances diagnostic accuracy and may serve as a practical screening tool for sarcopenia in this population.