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Prognostic performance of Asian Working Group for Sarcopenia 2019 and 2025 sarcopenia definitions in cirrhosis
Kei Endo1, Keisuke Kakisaka2, Tokio Sasaki2
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Idaidori 2-1-1, Yahaba, Iwate, 028-3695, Japan. keiendo@iwate-med.ac.jp.
Background/Purpose Of The Study:
The Asian Working Group for Sarcopenia (AWGS) updated its criteria in 2025, adding a body mass index (BMI)-adjusted muscle index (ASM/BMI) to the conventional skeletal muscle index (SMI). We aimed to compare the prognostic performances of the AWGS 2019 and AWGS 2025 in patients with liver cirrhosis.
Methods:
This retrospective cohort study included 505 patients ≥ 50 years of age with liver cirrhosis who underwent bioelectrical impedance analysis between 2016 and 2025. Sarcopenia was defined using the AWGS 2019 SMI, AWGS 2025 SMI, and AWGS 2025 ASM/BMI criteria. Landmark analysis was performed on day 180, and overall survival was evaluated. The prognostic performance was assessed using Cox regression, time-dependent ROC analysis, and Harrell's C-index.
Results:
During a median follow-up of 5.4 years, 140 deaths occurred. Sarcopenia, as defined by each definition, was independently associated with mortality. The baseline model (age, sex, etiology, and ALBI score) showed a C-index of 0.732. The addition of sarcopenia improved discrimination for SMI-based definitions (ΔC-index 0.033 for AWGS 2025 SMI; 0.023 for AWGS 2019 SMI) but not for AWGS 2025 ASM/BMI (ΔC-index 0.005). At 3 years, the AUC values were 0.828 (AWGS 2025 SMI), 0.822 (AWGS 2019 SMI), and 0.800 (AWGS 2025 ASM/BMI), relative to 0.792 for the baseline model.
Conclusions:
AWGS 2025 SMI demonstrated robust prognostic performance comparable to or slightly better than that of the AWGS 2019, whereas the AWGS 2025 ASM/BMI provided limited incremental prognostic value. The height-adjusted SMI remains a reliable metric for risk stratification in cirrhosis.
