Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study

Abstract

Background: Sarcopenia and body composition can be associated with mortality in chronic liver diseases (CLDs). We sought to identify predictors in CLD patients (n=631, 309 males) and create a prognostic model using easily available indexes.Methods: Reference values for low-grip strength (GS) were 26 kg in men and 18 kg in women. Reference values for low-skeletal muscle index (SMI) were 7.0 kg/m 2 in men and 5.7 kg/m 2 in women using bioelectrical impedance analysis (BIA). Reference values for low-calf circumference (CC) were 34 cm in men and 33 cm in women. Reference values for high-waist circumference were 85 cm in men and 90 cm in women. Using significant factors in the multivariate analysis contributing to the overall survival (OS), we created a simple predictive model. Akaike information criterion (AIC) was compared. Results: Men (P<0.0001), presence of liver cirrhosis (LC) (P<0.0001), presence of hepatocellular carcinoma (HCC) (P<0.0001), low-GS (P<0.0001), low-CC (P<0.0001), serum albumin (P=0.0355), estimated glomerular filtration rate (P=0.0461), hepatitis B virus (P=0.0044) and hepatitis C virus (P<0.0001) were significant factors contributing to the OS by the multivariate analysis. The study subjects were classified into the 4 groups (combined GS-SMI system): (I) low-GS and low-SMI (sarcopenia, n=73); (II) low-GS and high-SMI (n=65); (III) high-GS and low-SMI (n=110); and (IV) high-GS and high-SMI (n=383). The cumulative OS rates were well stratified among 4 groups (overall P<0.0001, AIC =360.895). The study subjects were also classified into the 4 groups (combined GS-CC system): (I) low-GS and low-CC (n=60); (II) low-GS and high-CC (n=78); (III) high-GS and low-CC (n=70); and (IV) high-GS and high-CC (n=423). The cumulative OS rates were also well stratified among 4 groups (overall P<0.0001, AIC =349.521). In receiver operating characteristic (ROC) curve analysis for CC based on the OS, the optimal cutoff point in men was 34.6 cm [area under the ROC (AUC) =0.70, sensitivity =0.558, specificity =0.842], and that in women was 32.8 cm (AUC =0.72, sensitivity =0.619, specificity =0.787).Conclusions: CC can be an alternative marker for muscle mass in CLD patients. Our proposed combined GS-CC system can be helpful in the community settings without special equipment for muscle mass measurement.

Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index–adjusted values

“…The frequency of patients with low CC according to raw values in the present study was 30.6%, adopting the cutoff points previously validated for the Brazilian population. Other studies using the same cutoff points found a frequency of low CC between 20.6% 25 and 57.0%, 26 with the highest frequencies observed in samples of patients with more advanced age, 11,13 and/or more impaired clinical status 26,27 . This is explained by the alterations in body composition related to age and the impact of burden disease and inflammation on muscle mass depletion.…”

Influencing Factors and Molecular Pathogenesis of Sarcopenia and Osteosarcopenia in Chronic Liver Disease

“…BCAA supplementation improves the survival rates of sarcopenic patients with LC [ 10 ]. A cohort study on 631 patients with CLD revealed that low grip strength and calf circumference were independent factors associated with overall survival [ 34 ]. Moreover, a recent retrospective multicenter study involving 1,624 patients with CLD demonstrated that low muscle strength was an independent predictor of mortality.…”

Risk of subsequent gastrointestinal disease assessed by skeletal muscle strength and mass in a prospective cohort study

“…However, whether skeletal muscle status can serve as an early indicator for subsequent gastrointestinal diseases remains unsatisfactorily answered. Current studies from several large cohorts have added to our understanding of the association of grip strength and muscle mass with gastrointestinal cancers and liver disease, 2 , 4 , 9 , 10 but there are inconsistencies in these results. Also, there is limited data on their association with other gastrointestinal diseases.…”