SARCOPENIA IN LIVER CIRRHOSIS

Abstract

Background. Sarcopenia presents the syndrome of progressive and generalized loss of skeletal muscle mass and muscle strength, with a risk of negative outcome, physical disability, poor quality of life and premature death. The aim of this article was to highlight some new issues about sarcopenia syndrome and contemporary approach in diagnostic and management approach of liver cirrhosis patients.

Material and methods. There was realized a contemporary literature analysis based on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier). The keyword used was Sarcopenia. The inclusion criteria served clinical practice guidelines and scientific articles about the contemporary knowledge: pathophysiology, management and medical treatment approach of sarcopenia. Exclusion criteria were articles that did not correspond to the actual search and information provided for patient’s needs and usage.

Results. Decompensated liver cirrhosis is the most common condition that can develop sarcopenia. Sarcopenia is an age-dependent syndrome. It causes side effects of physical and metabolic functions of the individual, with increased morbidity and mortality. Decompensated liver cirrhosis is characterized by muscle exhaustion, malnutrition and functional decline, with fragility development in 17-43% of patients. Fragile patients compared to non-fragile patients have higher MELD scores, lower levels of sodium and albumin, with a higher prevalence of hepatic encephalopathy. Preliminary testing of patients with fragility measurements at MELD-Na scores showed an improvement in predictability and a decrease in waiting list mortality.

Conclusions. Sarcopenia is associated with complications, infections, through a prolonged duration of hospitalization and increased postoperative mortality. Early identification by clinical-biochemical as well as imaging evaluations is an integral part of sarcopenic patients with liver cirrhosis. Management of sarcopenia requires tailored to the requirements and needs of each patient, focusing on high protein intake, regular meals, combined exercise, psychological counseling and optimization of basic liver disease.