Prevalence of and associated factors for sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Background Sarcopenia is associated with poor outcomes in patients with cirrhosis. However, the prevalence of and associated factors for developing sarcopenia in this population remain to be determined. Objectives This study aimed to summarize the prevalence, characteristics, and associated factors of sarcopenia in patients with cirrhosis. Methods Electronic searches were performed from inception to June 9, 2022 to identify the eligible studies. We meta-analyzed the prevalence of sarcopenia in overall patients with cirrhosis and subgroups. Both crude and adjusted odds ratios (ORs) were pooled using the random effects model. Results A total of 55 studies involving 13,158 patients from 17 countries were included. The overall prevalence of sarcopenia was 40.1 % (95 % CI 35.4%–44.9 %) in patients with cirrhosis. The pooled prevalence was higher in males, Child-Pugh class C cirrhosis, decompensated stage, ascites, subjective global assessment class C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index) at a higher cutoff. In multivariate analysis, older age (adjusted OR 1.04, 95 % CI 1.00–1.07), male (adjusted OR 4.75, 95 % CI 2.72–8.28), lower body mass index (BMI) (adjusted OR 0.78, 95 % CI 0.73–0.83), alcoholic liver disease (ALD) (adjusted OR 1.43, 95 % CI 1.19–1.72), but not ascites and hepatic encephalopathy, were significantly associated with an increased risk of sarcopenia in patients with cirrhosis. Conclusion Sarcopenia is a prevalent complication, and older age, male patients, lower BMI, and patients with ALD are associated with an increased risk of sarcopenia in patients with cirrhosis.