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Handgrip strength and diameter-product-derived psoas area estimate in end-stage liver cirrhosis: an exploratory
Eugen Malamutmann1, Christina Neuhaus2, Lale Umutlu3
1Department of General, Visceral, Vascular and Transplantation Surgery, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen, 45147, Germany. eugen.malamutmann@uk-essen.de.
Background:
Previous studies suggest that handgrip strength may correlate with muscle mass in cirrhosis, but validation across diverse transplant cohorts remains limited. We sought to validate whether previously reported correlations between handgrip strength and computed tomography (CT)-derived psoas-area estimates hold in a single-center cohort of liver transplant candidates and to explore whether a bedside prediction model could be derived.
Methods:
In this retrospective cohort study, 96 patients with end-stage liver cirrhosis undergoing transplant evaluation at University Hospital Essen (January 2020-December 2024) underwent standardized handgrip strength, 4-meter gait time, and diameter-product-derived psoas area estimates. Pearson correlation, multiple linear regression, and Cox proportional hazards analyses were performed with Benjamini-Hochberg correction for multiple comparisons.
Results:
Handgrip strength significantly correlated with total psoas area ([Formula: see text], 95% CI 0.16-0.51, [Formula: see text]). Multiple linear regression yielded a prediction model ([Formula: see text]) achieving 72% sensitivity and 68% specificity for sarcopenia detection (AUC = 0.74). In multivariate Cox regression, each 100 mm2/m2 increase in psoas index reduced waiting list mortality by 15% (HR = 0.85, 95% CI 0.73-0.98, [Formula: see text]) and post-transplant mortality by 18% (HR = 0.82, 95% CI 0.71-0.95, [Formula: see text]).
Conclusion:
Handgrip strength shows a modest, statistically significant association with diameter-product-derived psoas area estimates in liver transplant candidates. The derived prediction model has limited accuracy ([Formula: see text], AUC = 0.74) and cannot defer clinically indicated CT imaging; it may assist in identifying candidates who warrant confirmatory imaging or closer nutritional follow-up.
