Prognostic value of different sarcopenia assessment methods for mortality in patients with liver cirrhosis: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Sarcopenia is common among patients with cirrhosis and is closely associated with poor prognosis. However, the value of different methods for assessing sarcopenia in predicting mortality risk in patients with cirrhosis remains controversial. This study aims to systematically evaluate the predictive ability of different methods for measuring sarcopenia regarding mortality risk in patients with cirrhosis. METHODS: A systematic search was conducted in PubMed, Web of Science, and the Embase to identify studies evaluating the association between sarcopenia and the risk of mortality in patients with cirrhosis. The primary outcome measures were the hazard ratio (HR) and its 95% confidence interval. A meta-analysis was performed using a random-effects model, and subgroup analyses were conducted based on different assessment methods, including computed tomography (CT) imaging, handgrip strength (HGS), ultrasound (US), and dual-energy X-ray absorptiometry (DXA). RESULTS: A total of 15 studies were included. The overall meta-analysis results showed that sarcopenia significantly increased the risk of mortality in patients with cirrhosis. In the CT assessment group, the overall pooled HR was 2.06 (95% CI: 1.65-2.57). Subgroup analysis showed that the HR in the Skeletal Muscle Index (SMI) group was 1.88 (95% CI: 1.50-2.36), the Psoas Muscle Index/Psoas Muscle Thickness/Transverse Psoas Muscle Thickness (PMI/PMT/TPMT) group had an HR of 3.19 (95% CI: 1.62-6.28). The Handgrip Strength (HGS) group had an HR of 2.21 (95% CI: 1.61-3.05), suggesting a significant association between reduced handgrip strength and mortality risk. The HR for the US group was 2.11 (95% CI: 0.75-5.96), which did not reach statistical significance. The HR for the DXA group was 2.38 (95% CI: 1.47-3.84). After harmonizing effect estimates so that lower muscle mass represented the adverse exposure, indicating an increased mortality risk associated with reduced DXA-derived muscle mass. The strength and consistency of evidence varied across different assessment methods. CONCLUSION: Sarcopenia is associated with increased mortality risk in patients with cirrhosis. Among currently available assessment approaches, CT-derived measurements, particularly SMI, have the most consistent evidence base for mortality prediction. However, the limited number of studies evaluating HGS, ultrasound, and DXA prevents definitive conclusions regarding the comparative prognostic performance of different methods. Further large-scale prospective studies are required to validate the prognostic value of alternative assessment approaches. Future studies should establish standardized criteria for assessing sarcopenia to improve the accuracy of prognostic evaluations in patients with cirrhosis. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero, identifier CRD420261334377.