CORRELATION BETWEEN SARCOPENIA AND HEPATIC ENCEPHALOPATHY IN PATIENTS WITH CIRRHOSIS

Introduction and Objectives

Malnutrition is a frequent complication in patients with cirrhosis, associated with greater disease progression, complication rate, and mortality. Sarcopenia is one of the main indicators of malnutrition, characterized by a general decrease in muscle mass and functional deterioration. CT determination of muscle mass is not easily accessible in routine clinical practice, so practical measurement tools are essential. It has been proposed to classify sarcopenia as severe when decreased muscle strength, muscle mass, and low physical performance coexist. The impact of severe sarcopenia on the risk of developing hepatic encephalopathy is currently unknown. Primary outcome: Determine if there is a significant correlation between the degree of sarcopenia and hepatic encephalopathy. Secondary outcomes: to determine the prevalence of sarcopenia in patients with cirrhosis, the association between sarcopenia and liver decompensation events, to determine the correlation between individual tests (battery of functional physical performance tests [SPPB], grip strength, and skeletal muscle mass) with hepatic encephalopathy.

Materials and methods

Prospective, cross-sectional, observational, descriptive, and analytical study in patients with liver cirrhosis evaluated by outpatient consultation, with diagnosis confirmed by transitional elastography (Fibroscan® 502 ECHOSENS® equipment). The presence of sarcopenia was determined by measurement of grip strength with a hand-held hydraulic dynamometer (JAMAR® B001D7QDJG) and determination of muscle mass by tetrapolar electrical bioimpedance (OMRON® HBF 500). A positive case was considered when coexisting force ≤27 kg / ≤16 kg and skeletal muscle mass ≤20 kg / ≤15kg in men and women respectively, classifying it as severe sarcopenia with a score of ≤8 pts in SPPB. The presence of hepatic encephalopathy was determined by clinical evaluation and critical flicker rate (cut-off <39 Hz). Logistic regression analysis and Chi-square test were performed.

Results

96 patients were included, of which 35 (36.4%) had sarcopenia and 21 (60%) were classified as severe sarcopenia. The demographic characteristics and severity of cirrhosis were comparable in patients with and without sarcopenia. In multivariate logistic regression analysis, a significant correlation was demonstrated between the presence of sarcopenia and manifest hepatic encephalopathy p = 0.014, HR 9.05, 95% CI (1.54-52). No significant correlation was shown with ascites (p = 0.08) or recent variceal bleeding (p = 0.53). A significant correlation was demonstrated between previous events of encephalopathy (p = 0.021) and ascites (p = 0.032) with the presence of sarcopenia. Regarding individual tests, a SPPB score ≤8 was independently associated with overt encephalopathy (0.009, HR 19.7, 95% CI (2.1-182). Handgrip strength, chair stand, and muscle mass were not statistically significant.

Discussion and Conclusions

This pilot study suggests that the presence of sarcopenia is significantly correlated with the risk of developing overt hepatic encephalopathy, and the presence of previous ascites could increase the risk of developing sarcopenia. Evaluation of physical performance by SPPB could be independently correlated with the development of hepatic encephalopathy.

The authors declare that there is no conflict of interest