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Comparative Study
. 2025 May 29;9(6):e0701.
doi: 10.1097/HC9.0000000000000701. eCollection 2025 Jun 1.

Comparing the performance of 3 sarcopenia definitions for predicting adverse events prior to liver transplant

Heidi E Johnston  1   2   3 , Hannah L Mayr  1   3   4 , Melita Andelkovic  2   3   5 , Tahnie G Takefala  1   2 , Yanyan Chen  6 , Aaron P Thrift  6   7 , Graeme A Macdonald  2   3   5 , Ingrid J Hickman  1   3   8
Affiliations
Comparative Study

Comparing the performance of 3 sarcopenia definitions for predicting adverse events prior to liver transplant

Heidi E Johnston et al. Hepatol Commun. .

Abstract

Background: Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes.

Methods: The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia and receiving an LT, unplanned admissions pre-LT, surgical complications, and length of stay for the LT admission. Fine-Gray competing risk analysis explored the impact of sarcopenia on receiving an LT and unplanned admissions. The AUC determined the predictive utility of the criteria.

Results: The prevalence of CT-defined sarcopenia (52%) was more than twice and 4-fold that of EWGSOP1-defined (22%) and EWGSOP2-defined (11%) sarcopenia, respectively. No criteria demonstrated a significant association with time to LT nor the time to unplanned admissions pre-LT. Similarly, none of the 3 criteria had superior predictive utility for the clinical outcomes for unplanned hospital admissions pre-LT of receiving an LT, with all 3 criteria having identical moderate AUCs for unplanned admissions (0.70) and similar weak AUCs (≤0.55) for the likelihood of receiving an LT.

Conclusions: Sarcopenia in patients undergoing LT evaluation is prevalent. EWGSOP criteria appear to offer no advantage over CT-only criteria in identifying patients at increased risk of adverse LT outcomes. Bedside measures of muscle function may be of benefit in tracking the effectiveness of interventions targeting sarcopenia.

Keywords: advanced liver disease; cirrhosis; clinical risk assessment; low muscle mass; muscle wasting.

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Conflict of interest statement

The authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence curves including competing risks for study end point of liver transplantation for those with and without EWGSOP1-defined sarcopenia. *sHR 2.72, 95% CI: 1.34–5.51, p<0.001. Abbreviations: EWGSOP, European Working Group on Sarcopenia in Older People; LT, liver transplantation.
FIGURE 2
FIGURE 2
ROC analysis for unplanned admission predictions. The 4 lines indicate the AUROC with MELD alone and are adjusted to include each of the 3 sarcopenia definitions.
See this image and copyright information in PMC

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