Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis

Abstract

Background: Previous studies have shown that sarcopenia appears to be a significant contributor to physical frailty among outpatients with cirrhosis. However, the evidence is scant regarding the relationship between sarcopenia and multi-dimensional frailty among inpatients. We aimed to investigate the potential contribution of sarcopenia to frailty in hospitalized patients with cirrhosis in a sex-dependent manner. Methods: This cohort enrolled consecutive cirrhotics. Muscle quantity and quality were assessed using the computed tomography-based skeletal muscle index (SMI) and intramuscular adipose tissue content, respectively. Frailty phenotype was clarified by a self-reported Frailty Index. Multiple linear regression determined the association between sarcopenia and frailty phenotype. Results: A total of 202 cirrhotic patients with 48.5% male were included. The median Frailty Index was 0.13, rendering 17.3% subjects as frail. Among the 16 frail men, 68.8% had sarcopenia and 62.5% exhibited myosteatosis. In contrast, among the 19 frail women, 26.3% had sarcopenia and 15.8% exhibited myosteatosis. Frail patients had a significantly lower median SMI (42.80\u2009cm2/m2) compared with those with pre-frailty (48.23\u2009cm2/m2) and with robust status (50.82\u2009cm2/m2) in the male but not the female group. In male patients, multivariate linear regression implicated age (β\u2009=\u20090.330, p\u2009<\u20090.001), SMI (β\u2009=\u2009−0.260, p\u2009<\u20090.001), albumin (β\u2009=\u2009−0.245, p\u2009=\u20090.005), and sodium (β\u2009=\u2009−0.179, p\u2009=\u20090.037) as independent risk factors for frailty. Conclusion: Sarcopenia is associated with multi-dimensional frailty in male patients with cirrhosis. It is tempting to incorporate sex-specific intervention with the purpose of mitigating frailty among inpatients.