Feasibility and Mortality Prediction of Bedside Rectus Femoris Muscle Ultrasound for Sarcopenia Diagnosis in Liver Cirrhosis

Background: Sarcopenia is highly prevalent in patients with advanced liver cirrhosis (LC), serving as an independent risk factor for increased morbidity and mortality. This study evaluated the feasibility and prognostic impact of bedside rectus femoris muscle (RFM) ultrasound in patients with LC to identify patients at risk for sarcopenia.

Method: 84 patients with LC hospitalized at a tertiary centre (05/22–02/24) were prospectively included. Sarcopenia assessment within 24–48h of admission included handgrip strength, chair rise test (CRT), RFM ultrasound, and bioelectrical impedance analysis (BIA). Physical performance was measured by timed up and go (TUG) test and short physical performance battery (SPPB).

Results: 77% of patients had decompensated LC (CP B>CP C). The most common etiology was alcoholic LC. RFM thickness (MTRFM) and cross-sectional area (CSARFM) significantly decreased in CP C patients, also after normalizing for height (m²). AUROC for predicting low PhA (≤4.9°) by BIA was the highest for MTRFM/height² (0.723) and CSARFM/height² (0.758). Prolonged CRT and TUG test times were associated with lower MTRFM and CSARFM. Higher muscle echogenicity correlated with poorer TUG and SPPB performance. Patients with low RFM muscle mass had significantly shorter survival. Sarcopenia defined by prolonged CRT time and low CSARFM/height² effectively identified patients with highest HR (4.009; 95%CI 1.792-8.967) for mortality.

Conclusion: In patients with LC, ultrasound of RFM is a feasible bedside method for detecting those at risk for sarcopenia. Combined with muscle strength assessment, it effectively identifies patients at high mortality risk, highlighting its value as a practical tool for diagnosing sarcopenia.

Publication History

Article published online:
20 January 2025