Radiological Assessment of Sarcopenia and Its Association with Metabolic Markers in Patients with Liver Cirrhosis

Background: Cirrhosis is a progressive liver disease often associated with sarcopenia. Vitamin D and IGF-1 alterations may contribute to muscle loss and disease progression. This study evaluated their relationship in cirrhotic patients. Methods: A total of 90 patients with liver cirrhosis were included in this retrospective observational study. Clinical and laboratory data were collected, and disease severity was assessed using Child-Pugh and MELD-Na scores. Sarcopenia was evaluated using CT-based skeletal muscle index at the L3 level with sex-specific cut-offs. Patients with malignancy, acute liver failure, recent surgery, or muscle-affecting conditions were excluded. Vitamin D and IGF-1 levels were classified using standard and age-adjusted reference ranges. Results: A total of 90 patients were included, of whom 42 were alive, and 48 died during follow-up. Gender distribution was similar between groups (p = 0.388). Skeletal muscle area was significantly lower in non-survivors (110 vs. 140 cm², p = 0.002), while body mass index did not differ (p = 0.570). Vitamin D levels were significantly lower (10.0 vs. 17.9 ng/mL, p < 0.001), and hemoglobin levels were reduced in the non-survivor group (10.76 ± 2.13 vs. 12.87 ± 2.57 g/dL, p = 0.001). In multivariate analysis, age (OR 1.046, p = 0.032), MELD-Na score (OR 1.200, p = 0.001), and vitamin D level (OR 0.920, p = 0.024) were independently associated with mortality. Conclusions: CT-based sarcopenia assessment is a useful adjunct in cirrhosis when interpreted with disease severity. Radiological muscle depletion is common and associated with worse outcomes, while vitamin D deficiency independently associated with mortality, highlighting its potential as a biomarker and therapeutic target.