Low muscle mass predicts liver-related outcomes in cirrhosis, independent of portal hypertension: A retrospective cohort study.

Authors

Ikram Abow-Mohamed, Balqis Alabdulkarim, Xun Zhao, Dana Kablawi, Estelle Desgagné, Marc Deschenes, Philip Wong, Tianyan Chen, Giada Sebastiani, Benjamin Rehany, Mohamed Abu-Nada, David Valenti, Ali Bessissow, Amine Benmassaoud

Published in

Canadian liver journal. Volume 9. Issue 2. Pages 243-253. Epub Apr 07, 2026.

Abstract

Sarcopenia is associated with increased mortality in patients with cirrhosis, but this association remains unclear when adjusted for portal hypertension. We investigated the association of muscle mass and portal hypertension on liver-related events.
This retrospective study (2012-2022) included adult patients with cirrhosis and available hepatic venous pressure gradient (HVPG). Total cross-sectional skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at the third lumbar vertebrae (L3) were measured at the time of HVPG using CT imaging. Sarcopenia is defined as L3-SMI <39 cm²/m² in female and <50 cm²/m² in male patients. Logistic regression analyses assessed sarcopenia predictors; Cox regression analyses assessed liver-related events and mortality predictors.
A total of 121 patients were included (sarcopenia: 46%, female: 62%, mean age: 58.3 years, MASLD: 34%, median HVPG: 10 mmHg, median MELD score: 13, prior decompensation: 55%). Sarcopenia was more likely in patients with prior decompensation (70% versus 43%, p < 0.003), lower alanine aminotransferase (ALT) (21 versus 40 U/L, p < 0.001), and lower SATI (37.4 versus 76.4 cm²/m², p < 0.001). After age, prior decompensation, and ALT adjustments, SATI remained an independent predictor of sarcopenia (adjusted odds ratio aOR 0.98 [95% CI 0.97-0.99]). Over a median follow-up of 14.5 months, 59% had liver-related events and 29% died. After HVPG and MELD adjustments, which were significant factors, L3-SMI remained a predictor of liver-related events (adjusted hazard ratio [aHR] 0.98 [95% CI 0.95-0.99]) and mortality (aHR 0.96 [95% CI 0.92-0.99]).
Our study demonstrates that low muscle mass predicts liver-related events and mortality independently of portal hypertension and liver disease severity.

PMID:
42404990
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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