Diagnóstico de sarcopenia em indivíduos com cirrose hepática: concordância entre métodos de triagem e avaliação nutricional

Abstract

Introduction: Sarcopenia, recognized as a muscle disease characterized by a reduction in both the quality and quantity of muscle mass, has an estimated prevalence of 37.5% among patients with cirrhosis. Due to the symptomatic characteristics of these patients, such as ascites and edema, the assessment of muscle mass quality and quantity becomes a challenge. This study aims to identify the best diagnostic method for sarcopenia in patients with cirrhosis and to evaluate its concordance with subjective and anthropometric methods. Methodology: This study included patients with liver cirrhosis who did not have neoplasia or acute liver failure; were not pregnant or breastfeeding; did not have human immunodeficiency virus infection; were listed for liver transplantation due to special conditions (intractable pruritus, recurrent cholangitis, refractory ascites, persistent hepatic encephalopathy); and had a history of organ failure. For the subjective assessment of nutritional risk and status, the following were used: Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), RFH-Global Assessment (RFHGA), and Global Leadership Initiative on Malnutrition (GLIM). Body composition was analyzed using appendicular skeletal muscle mass (ASM) and its index (ASMI), diagnosed by dual-energy X-ray absorptiometry (DXA). Anthropometric assessment included body mass index (BMI) - calculated using dry weight - and measurements of arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and calf circumference (CC). Functional capacity was evaluated by measuring muscle strength using handgrip strength (HGS) and the chair stand test. For sarcopenia diagnosis, both the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) - starting with the SARCF and SARC-Calf screening questionnaires, followed by muscle strength and muscle composition assessments - and combined strength and composition indicators (excluding screening questionnaires) were used. Statistical analysis was performed using the Statistical Package for Social Science (SPSS®), version 26. To compare the performance of the SARC-F and SARC-Calf tests using their respective cut-off points (4 and 11), sensitivity, specificity, and positive and negative predictive values were calculated. The kappa concordance test (κ) was used to evaluate the agreement between methods. The alpha value was set at 5%. Results: A total of 45 patients were analyzed, with alcoholic liver disease being the most common etiology (44.4%). The SARC-Calf identified only 17.8% of the patients as being at risk of sarcopenia. Probable sarcopenia/skeletal muscle dysfunction was identified in 91.1% of the patients, according to the chair stand test. On the other hand, muscle depletion was diagnosed in 40% of the evaluated sample. The method with the highest prevalence of sarcopenia identification was the combination of the chair stand test with ASMI/SMI (42.2%). Among the traditional methods used in clinical practice, only the CC combined with the chair stand test showed moderate agreement with sarcopenia (κ = 0.536; p = 0.001). Conclusion: Our study shows that the algorithm proposed by EWGSOP2 leads to underdiagnosis of sarcopenia among patients with cirrhosis. The combination of the chair stand test with ASMI/SMI by DXA was the most effective in diagnosing individuals with sarcopenia. We suggest that the screening step be excluded for this population and that the chair stand test combined with CC can be used as an alternative when DXA is not feasible.