Sarcopenia in Decompensated Cirrhosis: A Comparative Analysis of Bioelectrical Impedance-Based Measures - 29/07/26

Doi : 10.1016/j.clinre.2026.102893

Maha Elsabaawy ^1,^2,^⁎ , Mohammed Ragab ¹, Maymona Al-Khalifa ³, Khaled Gamil ¹, Marwa Elfayoumy ¹

¹ Hepatology and Gastroenterology Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt

² Anesthesia and intensive care Nutrition Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt.

³ Therapeutic Nutrition Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt

^⁎ Corresponding author: Maha Elsabaawy, PhD., Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt. Hepatology and Gastroenterology Department National Liver Institute Menoufia University Shebeen El-Kom Egypt

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 29 July 2026

Highlights

•	The study population had a high prevalence of sarcopenia, ranging from 40% to 50% depending on the BIA-based measure used.
•	There was moderate to substantial agreement between sarcopenia measures, with ASM/Height² and ASM/Modified Weight showing the strongest agreement.
•	Sarcopenia, regardless of the measure used, was significantly associated with increased mortality and infection risk.
•	Phase angle emerged as a strong predictor of survival, with higher values associated with reduced mortality risk.
•	These results underscore the clinical relevance of sarcopenia in decompensated cirrhosis and highlight the need for standardized diagnostic criteria to improve risk stratification and patient managemen.

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Abstract

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.

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Keywords : Sarcopenia, Decompensated cirrhosis, Bioelectrical impedance analysis, Phase angle, Prognosis