This may be caused by the lack of a clear definition and the complexity of a nutritional assessment in patients with cirrhosis and fluid overload. Despite its high prevalence and important prognostic role, muscle wasting or sarcopenia, which is a major feature of malnutrition, has not been highlighted until recently.Ĭonventional prognostic scores for patients with cirrhosis, such as the Child-Turcotte-Pugh (CTP) score or the model for end-stage liver diseases (MELD) score, have limitations, including the lack of a nutritional status evaluation. Malnutrition is one of the most frequent complications in patients with cirrhosis, and it adversely affects other complications, quality of life, survival, and outcome after liver transplantation. Complications including ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, or hepatocellular carcinoma (HCC) are the most widely recognized. Therefore, management is generally focused on preventing and controlling complications. Although liver transplantation is the only curative treatment for cirrhosis, this option is not available for most patients. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research.Ĭirrhosis is a consequence of chronic liver injury that leads to necroinflammation, fibrosis, hepatocellular dysfunction, and vascular remodeling. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used however, revised models have been introduced to improve prognostic performance. Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease.
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