Prevalence and Significance of Combined Low Muscle Volume and High Muscle Fat in Patients with Child-Pugh A-B Cirrhosis.

BACKGROUND & AIMS: Physical frailty and sarcopenia are linked to adverse outcomes and higher healthcare utilisation in liver cirrhosis. A magnetic resonance imaging (MRI) assessment combining thigh muscle volume and muscle fat infiltration identifies muscle composition (MC) phenotypes, where adverse MC (high fat, low volume) independently predicts all-cause mortality. We aimed to determine MC prevalence, correlate MRI measurements with functional and physical performance tests, and characterise MC groups in patients with liver cirrhosis undergoing hepatocellular carcinoma (HCC) surveillance. METHODS: The ACCESS-ESLD study prospectively enrolled 150 patients with liver cirrhosis. An abbreviated MRI (for HCC surveillance and an assessment of muscle quantity and body fat), blood sampling (Child-Pugh, MELD 3.0), a Short Physical Performance Battery (SPPB) test, and a Liver Frailty Index (LFI) test were performed. RESULTS: Out of 150 patients (57% males, mean age 64±11 years, BMI 29.3±5.6 kg/m2), 44% had alcohol-related liver disease and 28% had MASLD. Ninety per cent were Child-Pugh A, and the mean MELD was 8.9. Adverse MC was found in 21% of patients, who showed higher LFI, poorer SPPB, and 1.6 L more visceral fat. No differences in Child-Pugh, MELD, decompensation history, type 2 diabetes, or BMI were observed. Muscle measurements strongly correlated with frailty and physical tests, with muscle fat most strongly linked to the LFI and the SPPB. CONCLUSIONS: Incorporating a concise MRI protocol to assess muscle health into HCC surveillance effectively identifies one in five patients with higher frailty and poorer physical performance, independent of liver disease status. Assessing both muscle fat and volume provides additional benefit beyond muscle volume alone. IMPACT AND IMPLICATIONS: This study provides scientific justification for utilising a concise magnetic resonance imaging (MRI) protocol to assess muscle health during MR-based HCC surveillance in patients with liver cirrhosis, demonstrating its feasibility as a combined MRI-based tool for integrated diagnostics. By effectively identifying patients with adverse muscle composition, linked to higher frailty and poorer physical performance, our findings highlight a patient cohort that warrants future targeted research and the development of specific clinical strategies. The findings suggest that assessing both muscle fat and volume provides a more comprehensive understanding of muscle health than assessing muscle volume alone, potentially leading to more effective management strategies. Future longitudinal data from ACCESS-ESLD will be vital to further explore long-term outcomes and inform the clinical utility of such integrated assessments, ultimately informing refined clinical practices and patient care. CLINICAL TRIAL NUMBER: NCT05502198.