The Five-Time Chair Stand Test Identifies Patients With Liver Cirrhosis at High Mortality Risk Overlooked by Conventional Sarcopenia Criteria.

BACKGROUND: Sarcopenia is a major complication of liver cirrhosis (LC), but current Japan Society of Hepatology (JSH) criteria are based on muscle mass and strength and do not incorporate physical performance. We investigated whether the five-time chair stand test (5T-CST) identifies high-risk patients not detected by conventional sarcopenia assessment. METHODS: We retrospectively analyzed 241 patients with LC who underwent the 5T-CST. Low physical performance was defined as a 5T-CST time ≥ 12 s. Patients were classified according to their handgrip strength and physical performance, with focus on those with normal handgrip strength. RESULTS: Longer 5T-CST duration was associated with lower handgrip strength and sarcopenia, but not low skeletal muscle mass index. Among 151 patients with normal handgrip strength and survival data, 27 (17.9%) had low physical performance. This subgroup had preserved muscle mass but more ascites and hepatic reserve impairment and lower survival (mortality, 29.6% vs. 12.1%; log-rank p = 0.007). In a principal analysis restricted to this subgroup, adjusted for mALBI grade and hepatocellular carcinoma (HCC), low physical performance independently predicted mortality (hazard ratio, 4.70; 95% CI, 1.94-11.37; p < 0.001). In the overall cohort (n = 237), it remained predictive after adjustment for age, sex, mALBI grade, HCC, and sarcopenia (hazard ratio, 2.74; 95% CI, 1.45-5.16; p = 0.002). CONCLUSIONS: Among patients with LC and normal handgrip strength, the 5T-CST identified a subgroup at a high risk of mortality. Adding this simple test to sarcopenia assessment may help identify patients otherwise missed by handgrip strength alone.