Muscular abnormalities in liver cirrhosis

Abstract

Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease. Data regarding its clinical significance and consequences in the course of liver disease have been growing; many of the data support the idea that it impacts decompensation event frequency, prolonged hospitalization, and mortality, as well as providing the possibility to better prioritize patients on lists awaiting liver transplantation. When assessing the whole clinical scope of the field, which includes malnutrition and frailty, as well as the complete spectrum of muscle mass, strength, and function, it becomes clear that a well-founded approach in everyday clinical practice is essential. In this respect, this article attempts to unveil the most recently published data regarding possible methods and modalities that could be used to diagnose sarcopenia as early as possible, along with the required accuracy and reliability. From the most important field discoveries to data that need further clarification, the merits and weaknesses of the very diverse existing evaluation methods are presented. Finally, a critical overview is given, in an attempt to discern study lines of importance from those that could pose further ambiguity for the theme. The author also poses relevant questions that remain unanswered but are of clinical importance in the field.

Keywords: Sarcopenia; Liver cirrhosis; Frailty; Muscle strength; Nutrition indices; Risk factors

Core Tip: Knowledge regarding the influence of sarcopenia in the course of chronic liver disease has greatly expanded in the past ten years, especially with respect to cirrhosis. Data show that it has a great influence on disease decompensation and patient mortality, providing clues for the development of newer evaluation modalities and sarcopenia indices. Nonetheless, data regarding the therapeutic consequences and interventions remain scarce. This article attempts to summarize the current state of knowledge of this important clinical topic with a critical evaluation of some related groundbreaking studies.