title: Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score.
abstract: Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research.
authors.affiliation: Hee Yeon Kim, Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Hee Yeon
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Hee Yeon Kim, Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
mesh_terms: D003661:Decision Support Techniques; D018450:Disease Progression; D006305:Health Status Indicators; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018482:Muscle, Skeletal / Q000473:pathology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
keywords: Liver cirrhosis; Model for end-stage liver diseases score; Mortality; Prognosis; Sarcopenia