Ujwal gajula
MBBS, Department of hepatology, Apollo hospital, Chennai, India
Title: Assessment of sarcopenia in patients with chronic liver disease
Biography
Biography: Ujwal gajula
Abstract
Introduction: sarcopenia is one of the most common complications of cirrhosis which adversely affects survival, quality of life and overall outcome. Aim: To assess the prevalence of sarcopenia in patients with chronic liver disease and correlate sarcopenia with severity of liver disease. Methods: Computed tomography (CT) was performed to assess sarcopenia in all patients as per the protocol. Sarcopenia was compared with other modalities of nutritional assessment such as SGA and HGS in the study. Results: A total of the 95 patients included. The mean age of the study population was 50.82 (+/-9.5 SD) years. Gender specific Psoas muscle index cut-off values to define sarcopenia were derived from a pilot study of sixty healthy adults between the age group 20-30 yrs. These cut-off values were <5.67 cm2/m2 in males and <3.57 cm2/ m2 in females. Prevalence of sarcopenia from these cut-off values was sixty one percent (61%) in the study. On univariate analysis, bilirubin, albumin, INR, hemoglobin, MELD, CTP score were associated with sarcopenia. Complications of the chronic liver disease such as ascites, hepatic encephalopathy and jaundice and AKI were more commonly seen in patients with sarcopenia (P-value <0.005). Prevalence of malnutrition by subjective global assessment was 49.5% in the study. Prevalence of impaired hand grip strength estimated from the gender and age specific normal reference values was 63.2% (60/95). Conclusions: Prevalence of sarcopenia in chronic liver disease was 61% in the present study. Sarcopenia was correlated with the severity of chronic liver disease (assessed by CTP score and MELD score). Bilirubin, albumin, INR, hemoglobin were associated with sarcopenia in the study. Presence of complications of the liver disease such as ascites and hepatic encephalopathy, AKI were associated with sarcopenia. Nutritional assessment methods such as Subjective global assessment (SGA) and hand grip strength (HGS) were able to exclude / predict sarcopenia in majority of the CLD patients with CTP class A and C.SGA and HGS can be used as a screening tool to assess nutritional status in these patients. In patients with CTP class B, neither SGA nor HGS were able to predict sarcopenia accurately.