Sarcopenia in decompensated cirrhosis: a comparative analysis of bioelectrical impedance-based measures.

BACKGROUND

Sarcopenia is highly prevalent in decompensated cirrhosis and strongly associated with adverse clinical outcomes. While bioelectrical impedance analysis (BIA) offers multiple body composition indices, the optimal approach remains uncertain.

AIM: To evaluate the prevalence and comparative prognostic performance of Phase Angle (PA) versus other BIA-derived sarcopenia indices in patients with decompensated cirrhosis.

METHODS

This prospective observational study included 155 patients with decompensated cirrhosis and ascites who underwent multi-frequency BIA. Sarcopenia was defined using sex-specific cutoffs for PA and four additional BIA-derived indices. Prognostic associations with mortality and infections were assessed through fully adjusted logistic and Cox regression models.

RESULTS

Sarcopenia prevalence ranged between 40% and 50% across indices in the primary analysis. Although prevalence estimates were comparable, PA demonstrated superior prognostic performance. Low PA was independently associated with increased 12-month mortality (OR 2.28, 95% CI 1.52-3.42; p < 0.001) and infection risk (OR 1.95, 95% CI 1.32-2.88; p = 0.001), outperforming mass-based indices even after extensive adjustment. Each 1° increase in PA was associated with a 29% reduction in mortality risk (HR 0.71, 95% CI 0.55-0.91; p = 0.008). These associations remained consistent across clinically relevant subgroups, including different ascites severities, Child-Pugh classes, and HCC status. PA also strongly predicted 90-day mortality and hospital readmissions.

CONCLUSIONS

In patients with decompensated cirrhosis, PA provides significant added prognostic value beyond traditional BIA-derived muscle mass indices. This readily available bedside parameter may enhance risk stratification and support individualized nutritional and rehabilitative interventions. Its incremental utility warrants further validation in larger multicenter studies.