Prevalence and prognosis of Computed-Tomography defined sarcopenia in Tunisian cirrhotic patients


Shema Ayadi
Myriam Jrad
Ines Briki
Myriam Ayari
Yosra Zaimi
Mouelhi Leila
Radhouane Debbeche


Introduction: Sarcopenia is an underdiagnosed and understudied complication of cirrhosis, especially in patients not undergoing liver transplantation.

Aim: To evaluate the prevalence and prognostic impact of radiological sarcopenia in non-transplanted cirrhotic patients.

Methods: Longitudinal retrospective study including cirrhotic patients explored by an abdominal CT scan, over a period of 6 years, in a single gastroenterology department in Tunisia. Sarcopenia was defined according to transversal psoas muscle thickness normalized to height (TPMT/h) in the sagittal CT slice. Two groups were defined: Group 1 with sarcopenia (TPMT/h <16.8mm/m); and Group 2 without sarcopenia (TPMT/h ≥16.8mm/m).

Results: Seventy patients were included (mean age=62 years). The mean MELD score was 12.81 and the mean TPMT/h of 13.56 mm/m. Forty-four patients were sarcopenic (63%). When included, the 2 groups’ baseline characteristics were comparable except for women predominance and refractory ascites in group 1. After an average of 21-month follow-up, sarcopenia was associated with a higher number of complications per patient (p=0.013) and a longer average hospital stay duration per patient (p=0.001). Overall survival was significantly decreased in sarcopenic patients (p=0.035). Survival rates at 6 months, 1 year, and 2 years were respectively 42%, 30%, and 24% in Group 1 versus 67%, 40%, and 27% in Group 2. Sarcopenia was an independent factor of mortality in multivariate analysis (OR=2.5; 95% IC [1.02-6.16]; p=0.045).

Conclusion: Sarcopenia is frequent and an independent poor prognostic factor in cirrhosis. TPMT/h is an easy and often available method for sarcopenia diagnosis.



sarcopenia, malnutrition, cirrhosis, computed tomography, prognosis, mortality



  1. Merli M, Berzigotti A, Zelber-Sagi S, Dasarathy S, Montagnese S, Genton L, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. janv 2019;70(1):172‑93.
  2. Buchard B, Boirie Y, Cassagnes L, Lamblin G, Coilly A, Abergel A. Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice? Nutrients. janv 2020;12(1):186.
  3. Huguet A, Latournerie M, Debry PH, Jezequel C, Legros L, Rayar M, et al. The psoas muscle transversal diameter predicts mortality in patients with cirrhosis on a waiting list for liver transplantation: A retrospective cohort study. Nutrition. 1 juill 2018;51‑52:73‑9.
  4. Montano-Loza AJ, Meza-Junco J, Prado CMM, Lieffers JR, Baracos VE, Bain VG, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. févr 2012;10(2):166‑73, 173.e1.
  5. Montano-Loza AJ, Meza-Junco J, Baracos VE, Prado CMM, Ma M, Meeberg G, et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. juin 2014;20(6):640‑8.
  6. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatol Baltim Md. août 2014;60(2):715‑35.
  7. Durand F, Buyse S, Francoz C, Laouénan C, Bruno O, Belghiti J, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. J Hepatol. 1 juin 2014;60(6):1151‑7.
  8. Lai JC, Tandon P, Bernal W, Tapper EB, Ekong U, Dasarathy S, et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(3):1611‑44.
  9. Bertuzzo VR, Renzulli M, Clemente A, Cucchetti A, Maroni L, Frascaroli G, et al. Pre-transplant Psoas Muscle Density as a Ready-to-Use and Low-cost Predictor of Patient Survival After Liver Transplant. Hepat Mon [Internet]. 1 juin 2021 [cité 16 nov 2022];21(4). Disponible sur:
  10. Hanai T, Shiraki M, Nishimura K, Ohnishi S, Imai K, Suetsugu A, et al. Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition. 1 janv 2015;31(1):193‑9.
  11. Ennaifer R, Cheikh M, Romdhane H, Sabbagh S, Ben Nejma H, Bougassas W, et al. Does protein energy malnutrition affect the outcome in Tunisian cirrhotic patients? Tunis Med. févr 2016;94(2):172‑6.
  12. Houissa F, Salem M, Debbeche R, Mouelhi L, Bouzaidi S, Ben Rejeb M, et al. Evaluation of nutritional status in patients with liver cirrhosis. Tunis Med. févr 2010;88(2):76‑9.
  13. Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clin Nutr. 1 déc 2020;39(12):3533‑62.
  14. Hu G, Jousilahti P, Antikainen R, Katzmarzyk PT, Tuomilehto J. Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure. Circulation. 19 janv 2010;121(2):237‑44.
  15. Merli M, Giusto M, Lucidi C, Giannelli V, Pentassuglio I, Di Gregorio V, et al. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study. Metab Brain Dis. juin 2013;28(2):281‑4.
  16. Dasarathy S. Consilience in sarcopenia of cirrhosis. J Cachexia Sarcopenia Muscle. 1 déc 2012;3(4):225‑37.
  17. Dam G, Ott P, Aagaard NK, Vilstrup H. Branched-chain amino acids and muscle ammonia detoxification in cirrhosis. Metab Brain Dis. 1 juin 2013;28(2):217‑20.
  18. Bhanji RA, Carey EJ, Yang L, Watt KD. The Long Winding Road to Transplant: How Sarcopenia and Debility Impact Morbidity and Mortality on the Waitlist. Clin Gastroenterol Hepatol. 1 oct 2017;15(10):1492‑7.
  19. Paternostro R, Lampichler K, Bardach C, Asenbaum U, Landler C, Bauer D, et al. The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. Liver Int Off J Int Assoc Study Liver. déc 2019;39(12):2374‑85.
  20. Welch N, Attaway A, Bellar A, Alkhafaji H, Vural A, Dasarathy S. Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age. Nutrients. 18 févr 2021;13(2):659.
  21. Vural A, Attaway A, Welch N, Zein J, Dasarathy S. Skeletal muscle loss phenotype in cirrhosis: A nationwide analysis of hospitalized patients. Clin Nutr. 1 déc 2020;39(12):3711‑20.
  22. Vugt JLA van, Levolger S, Bruin RWF de, Rosmalen J van, Metselaar HJ, IJzermans JNM. Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation. Am J Transplant. 2016;16(8):2277‑92.
  23. Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, Baracos VE, Sawyer MB, Pang JXQ, et al. Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. Clin Transl Gastroenterol. 16 juill 2015;6:e102.