Portal Hypertension & Cirrhosis (Jun 2023)

The relationship between sarcopenia, multidimensional frailty, and malnutrition cluster and long‐term mortality in hospitalized patients with cirrhosis

  • Gaoyue Guo,
  • Han Wang,
  • Wanting Yang,
  • Chaoqun Li,
  • Xingliang Zhao,
  • Xiaofei Fan,
  • Yangyang Hui,
  • Binxin Cui,
  • Xiaoyu Wang,
  • Xuqian Zhang,
  • Kui Jiang,
  • Chao Sun

DOI
https://doi.org/10.1002/poh2.50
Journal volume & issue
Vol. 2, no. 2
pp. 51 – 60

Abstract

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Abstract Aim Sarcopenia, multidimensional frailty, and malnutrition represent common debilitating conditions in the context of cirrhosis, linked to a variety of dismal outcomes. We aimed to clarify their overlap and cumulative impact on long‐term mortality in hospitalized patients with cirrhosis. Methods Consecutive patients with cirrhosis were prospectively recruited from January 2018 to December 2020. The diagnosis of sarcopenia, multidimensional frailty, and malnutrition was standardized according to the consensus definition and our well‐documented criteria. The prevalence of the respective debilitating condition and the concurrence of this comorbidity were calculated. Results In total, 253 patients with cirrhosis aged 64 years with a female predominance (52.4%) were recruited. Sarcopenia was present in 20.9% (53/253), multidimensional frailty in 12.6% (32/253), and malnutrition in 44.7% (113/253) of the entire cohort. Approximately half of the patients had at least one debilitating condition (127/253). Sarcopenia and malnutrition co‐existed in 33 nonfrail patients (13.0%) and multidimensional frailty and malnutrition in eight nonsarcopenic patients (3.2%). Fifteen (5.9%) subjects had all three debilitating conditions, namely malnutrition, sarcopenia, and frailty (MSF) group. The proportions of males, infections, and ascites were significantly higher in the MSF group. Patients in the MSF group had the highest levels of neutrophil‐to‐lymphocyte ratio and creatinine. The 2‐year mortality rates in patients with three debilitating conditions, two conditions, one condition, and no conditions were 60.0%, 23.8%, 21.4%, and 13.5%, respectively. Multivariate Cox regression indicated the long‐term mortality risk was approximately four‐fold higher among patients in the MSF group compared to those with no conditions. Conclusions A fraction of patients with cirrhosis exhibited comorbidities of sarcopenia, multidimensional frailty, and malnutrition, linked to a higher risk of long‐term mortality.

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