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Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3652–3659 | Cite as

Bedside Measures of Frailty and Cognitive Function Correlate with Sarcopenia in Patients with Cirrhosis

  • Elliot B. TapperEmail author
  • Brian Derstine
  • Jad Baki
  • Grace L. Su
Original Article

Abstract

Background

Frailty and sarcopenia are associated with mortality and poor outcomes among patients with cirrhosis. Frailty is multifactorial but due in part to sarcopenia and cognitive dysfunction. Data are limited regarding the correlation of bedside frailty and cognitive function measures with sarcopenia.

Aims

To evaluate the correlations between frailty measures and muscle indices from computed tomography (CT).

Methods

We prospectively enrolled 106 patients with clinically compensated cirrhosis (and no prior hepatic encephalopathy). All patients underwent CT scan and cognitive testing (via inhibitory control test, ICT), and were subject to hand grip, 30-s chair stands, mid-arm muscle area (MAMA), and a four-question algorithm based on the Sickness Impact Profile (SIP) predictive of minimal HE. We evaluated Spearman correlations between all measures as well as the sensitivity and specificity of each measure for falls.

Results

In total, 106 (35.3%) patients (55 men) had CT scans to measure skeletal muscle area and quality. Hand grip correlated strongly with skeletal muscle area (correlation coefficient 0.64, p < 0.001) and mildly with ICT performance (0.34, p = 0.002). However, for women, the strongest correlation with hand grip was ICT performance (0.60, p < 0.001). Chair stand performance correlated best with SIP (correlation coefficient − 0.35, p < 0.001). MAMA was not correlated with CT-based muscle indices among women but was for men. Poor chair stand performance (< 10/30-s) had a sensitivity/specificity for falls of 73%/54%; low muscle radiation attenuation (density) was 40%/80% sensitive/specific.

Conclusion

Bedside measures of physical function, muscle bulk, and cognitive performance are correlated with CT-based muscle measures. Bedside measures of frailty may provide an advantage over sarcopenia for outcome assessment that should be confirmed prospectively.

Keywords

Liver disease Falls Portal hypertension Hepatic encephalopathy 

Notes

Funding

Elliot Tapper receives funding from the National Institutes of Health through the Michigan Institute for Clinical and Health Research (KL2TR002241).

Compliance with Ethical Standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Elliot B. Tapper
    • 1
    • 2
    Email author
  • Brian Derstine
    • 3
  • Jad Baki
    • 4
  • Grace L. Su
    • 1
    • 2
  1. 1.Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborUSA
  2. 2.Gastroenterology SectionVA Ann Arbor Healthcare SystemAnn ArborUSA
  3. 3.Morphomic Analysis GroupUniversity of MichiganAnn ArborUSA
  4. 4.University of MichiganAnn ArborUSA

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