Frailty Rather Than Sonographic Muscle Measurement Predicts Outcome in Liver Cirrhosis
- 1Department of Internal Medicine I University Medical Center of the Johannes Gutenberg‐University Mainz Germany
Abstract
Background: Sarcopenia and frailty are frequent in patients with liver cirrhosis and are associated with morbidity and mortality. Given the limitations of computed tomography (CT) for routine assessment of muscle loss and the need for practical bedside assessment, we aimed to compare sonographic muscle thickness measurement and the Clinical Frailty Scale (CFS) for their prognostic value in patients with liver cirrhosis.
Methods: In this study, data of prospectively recruited patients with liver cirrhosis (both in‐ and outpatients) treated at a tertiary care centre were retrospectively analysed. Sonographic muscle thickness measurement was used to calculate the feather thigh muscle thickness index (fTMTI) and the compression thigh muscle thickness index (cTMTI). Frailty was assessed using the Clinical Frailty Scale. Patients were followed for liver transplantation or death.
Results: In total, 153 patients were included with a median Model for End‐Stage Liver Disease (MELD) of 18 (Interquartile range (IQR) 10; 24). Ninety‐five patients (62.0%) were male, and 70 patients (46%) were recruited in the outpatient setting. During the 90‐day follow‐up period, 71 patients (46.4%) either died or underwent liver transplantation. Outpatients had more muscle mass than inpatients and a lower CFS (fTMTI 19.1 mm/m vs. 12.1 mm/m, p < 0.001 and CFS 3 vs. 5, p < 0.001). In multivariable Cox‐regression models adjusted for age and MELD score, a higher CFS remained independently associated with mortality and liver transplantation (LT) (HR 1.25 (1.14; 1.63), p < 0.001), whereas fTMTI and cTMTI were not consistently associated with a poorer prognosis (fTMTI HR 1.52 (0.68; 3.42), p = 0.300; cTMTI HR 1.01 (0.61; 1.68), p > 0.9). Subgroup analyses in men confirmed a superior prognostic value of CFS (HR 1.51 (1.17; 1.94), p = 0.001) over sonographic muscle thickness measurement (cTMTI HR 0.94 (0.84; 1.04), p = 0.200; fTMTI HR 0.93 (0.88; 1.00), p = 0.039).
Conclusion: CFS is robustly associated with poorer prognosis in patients with liver cirrhosis and seems to be superior to sonographic muscle thickness measurement of the thigh.
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BibTeX
@article{kremer2026frailty,
title = {{Frailty Rather Than Sonographic Muscle Measurement Predicts Outcome in Liver Cirrhosis}},
author = {Wolfgang Maximilian Kremer and Alexander Schwarz and Marie‐Claire Dumont and Simon Johannes Gairing and Visvakanth Sivanathan and Peter Robert Galle and Martin Franz Sprinzl and Eva Maria Schleicher and Christian Labenz},
journal = {Journal of Cachexia, Sarcopenia and Muscle},
year = {2026},
month = oct,
doi = {10.1002/jcsm.70373},
url = {https://doi.org/10.1002/jcsm.70373},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Frailty Rather Than Sonographic Muscle Measurement Predicts Outcome in Liver Cirrhosis
AU - Wolfgang Maximilian Kremer
AU - Alexander Schwarz
AU - Marie‐Claire Dumont
AU - Simon Johannes Gairing
AU - Visvakanth Sivanathan
AU - Peter Robert Galle
AU - Martin Franz Sprinzl
AU - Eva Maria Schleicher
AU - Christian Labenz
PY - 2026
DA - 2026/10/27
JO - Journal of Cachexia, Sarcopenia and Muscle
DO - 10.1002/jcsm.70373
UR - https://doi.org/10.1002/jcsm.70373
AB - Background: Sarcopenia and frailty are frequent in patients with liver cirrhosis and are associated with morbidity and mortality. Given the limitations of computed tomography (CT) for routine assessment of muscle loss and the need for practical bedside assessment, we aimed to compare sonographic muscle thickness measurement and the Clinical Frailty Scale (CFS) for their prognostic value in patients with liver cirrhosis. Methods: In this study, data of prospectively recruited patients with liver cirrhosis (both in‐ and outpatients) treated at a tertiary care centre were retrospectively analysed. Sonographic muscle thickness measurement was used to calculate the feather thigh muscle thickness index (fTMTI) and the compression thigh muscle thickness index (cTMTI). Frailty was assessed using the Clinical Frailty Scale. Patients were followed for liver transplantation or death. Results: In total, 153 patients were included with a median Model for End‐Stage Liver Disease (MELD) of 18 (Interquartile range (IQR) 10; 24). Ninety‐five patients (62.0%) were male, and 70 patients (46%) were recruited in the outpatient setting. During the 90‐day follow‐up period, 71 patients (46.4%) either died or underwent liver transplantation. Outpatients had more muscle mass than inpatients and a lower CFS (fTMTI 19.1 mm/m vs. 12.1 mm/m, p < 0.001 and CFS 3 vs. 5, p < 0.001). In multivariable Cox‐regression models adjusted for age and MELD score, a higher CFS remained independently associated with mortality and liver transplantation (LT) (HR 1.25 (1.14; 1.63), p < 0.001), whereas fTMTI and cTMTI were not consistently associated with a poorer prognosis (fTMTI HR 1.52 (0.68; 3.42), p = 0.300; cTMTI HR 1.01 (0.61; 1.68), p > 0.9). Subgroup analyses in men confirmed a superior prognostic value of CFS (HR 1.51 (1.17; 1.94), p = 0.001) over sonographic muscle thickness measurement (cTMTI HR 0.94 (0.84; 1.04), p = 0.200; fTMTI HR 0.93 (0.88; 1.00), p = 0.039). Conclusion: CFS is robustly associated with poorer prognosis in patients with liver cirrhosis and seems to be superior to sonographic muscle thickness measurement of the thigh.
SN - 2190-5991
SN - 2190-6009
ER -