Comparative assessment of ultrasound and bioelectrical impedance analysis for sarcopenia screening in chronic liver disease.

BACKGROUND

Sarcopenia, primarily defined by low muscle mass (LMM), is associated with worse clinical outcomes in chronic liver disease (CLD). Diagnosis is challenging due to the lack of standardized tools. Ultrasound (US) offers a promising method for muscle mass assessment but requires validation against reference methods like bioelectrical impedance analysis (BIA).

AIM: To evaluate the correlation and agreement between US- and BIA-based muscle measurements and the accuracy of US in identifying sarcopenia in patients with cirrhosis and a history of hepatocellular carcinoma (HCC).

METHODS

In this prospective observational study, 88 patients with cirrhosis (HCC active or under follow-up) underwent muscle mass assessment by BIA and US of quadriceps and psoas muscles. Analyses included correlations, intraclass correlation (ICC), Bland-Altman plots, and ROC analysis to determine US cut-offs for sarcopenia.

RESULTS

Quadriceps US indices correlated with BIA-derived ASMM/h² (r = 0.35-0.45, p < 0.01), with high inter-rater reliability (ICC 0.83-0.96). The feather index demonstrated the best discriminative ability (AUROC 0.81, sensitivity 83%, specificity 72%) in this low-prevalence setting. Dual cut-off strategies improved screening value (negative predictive values above 97%).

CONCLUSION

Muscle US is a reliable, non-invasive screening tool for sarcopenia (specifically LMM) in CLD patients. Its use can reduce reliance on complex diagnostics, enabling early detection and improved clinical management.