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Published on: March 21, 2021
Sarcopenia in decompensated cirrhosis: a comparative analysis of bioelectrical impedance-based measures
Maha Elsabaawy1, Mohammed Ragab2, Maymona Al-Khalifa3
1Hepatology and Gastroenterology Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt; Therapeutic Nutrition Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt.
Background:
Sarcopenia is highly prevalent in decompensated cirrhosis and strongly associated with adverse clinical outcomes. While bioelectrical impedance analysis (BIA) offers multiple body composition indices, the optimal approach remains uncertain.
Aim:
To evaluate the prevalence and comparative prognostic performance of Phase Angle (PA) versus other BIA-derived sarcopenia indices in patients with decompensated cirrhosis.
Methods:
This prospective observational study included 155 patients with decompensated cirrhosis and ascites who underwent multi-frequency BIA. Sarcopenia was defined using sex-specific cutoffs for PA and four additional BIA-derived indices. Prognostic associations with mortality and infections were assessed through fully adjusted logistic and Cox regression models.
Results:
Sarcopenia prevalence ranged between 40% and 50% across indices in the primary analysis. Although prevalence estimates were comparable, PA demonstrated superior prognostic performance. Low PA was independently associated with increased 12-month mortality (OR 2.28, 95% CI 1.52-3.42; p < 0.001) and infection risk (OR 1.95, 95% CI 1.32-2.88; p = 0.001), outperforming mass-based indices even after extensive adjustment. Each 1° increase in PA was associated with a 29% reduction in mortality risk (HR 0.71, 95% CI 0.55-0.91; p = 0.008). These associations remained consistent across clinically relevant subgroups, including different ascites severities, Child-Pugh classes, and HCC status. PA also strongly predicted 90-day mortality and hospital readmissions.
Conclusions:
In patients with decompensated cirrhosis, PA provides significant added prognostic value beyond traditional BIA-derived muscle mass indices. This readily available bedside parameter may enhance risk stratification and support individualized nutritional and rehabilitative interventions. Its incremental utility warrants further validation in larger multicenter studies.
