Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study

Abstract Background Sarcopenia, characterized by loss of muscle mass and function, has gained importance in the evaluation of cirrhotic patients. Evidence suggests its role in adverse clinical outcomes, including minimal hepatic encephalopathy (MHE). This study aimed to investigate the association b...

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Main Authors: Wasit Wongtrakul, Wimolrak Bandidniyamanon, Phunchai Charatcharoenwitthaya
Format: Article
Language:English
Published: BMC 2025-02-01
Series:BMC Gastroenterology
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Online Access:https://doi.org/10.1186/s12876-025-03674-9
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author Wasit Wongtrakul
Wimolrak Bandidniyamanon
Phunchai Charatcharoenwitthaya
author_facet Wasit Wongtrakul
Wimolrak Bandidniyamanon
Phunchai Charatcharoenwitthaya
author_sort Wasit Wongtrakul
collection DOAJ
description Abstract Background Sarcopenia, characterized by loss of muscle mass and function, has gained importance in the evaluation of cirrhotic patients. Evidence suggests its role in adverse clinical outcomes, including minimal hepatic encephalopathy (MHE). This study aimed to investigate the association between sarcopenia and MHE in patients with cirrhosis. Methods We prospectively enrolled outpatients with cirrhosis to assess sarcopenia using the 2019 criteria from the Asian Working Group for Sarcopenia. MHE was diagnosed through the Psychometric Hepatic Encephalopathy Score. Results Of the 210 cirrhotic patients (57.1% male, mean age 62.7 ± 9.6 years), 54 (25.7%) had sarcopenia, with 26 (12.3%) classified as severe. Thirty-seven patients (17.6%) were diagnosed with MHE. Sarcopenia prevalence was significantly higher in patients with MHE compared to those without MHE (45.9% vs. 21.4%). MHE was significantly associated with age, education level, Mini-Mental State Examination score, and a history of hepatic decompensation. No significant associations were found regarding gender, body mass index, comorbidities, sleep quality, and the etiology of cirrhosis. Multivariable logistic regression showed that MHE was significantly associated with age (adjusted odds ratio [aOR] 1.08, 95% CI 1.02–1.13), sarcopenia (aOR 3.29, 95% CI 1.44–7.50), history of overt hepatic encephalopathy (aOR 7.40, 95% CI 1.20-45.56), and variceal bleeding (aOR 3.13, 95% CI 1.38–7.10). Severe sarcopenia was also independently associated with MHE (aOR 3.64, 95% CI 1.32–10.05). Conclusions Sarcopenia is prevalent in cirrhotic patients and is associated with an increased risk of MHE. Our findings emphasize the importance of assessing sarcopenia to potentially mitigate MHE risk in managing patients with cirrhosis.
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spelling doaj-art-b62bc6e32ec443c9b5be7f8723a4a0e82025-08-20T02:15:11ZengBMCBMC Gastroenterology1471-230X2025-02-0125111110.1186/s12876-025-03674-9Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational studyWasit Wongtrakul0Wimolrak Bandidniyamanon1Phunchai Charatcharoenwitthaya2Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDivision of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDivision of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background Sarcopenia, characterized by loss of muscle mass and function, has gained importance in the evaluation of cirrhotic patients. Evidence suggests its role in adverse clinical outcomes, including minimal hepatic encephalopathy (MHE). This study aimed to investigate the association between sarcopenia and MHE in patients with cirrhosis. Methods We prospectively enrolled outpatients with cirrhosis to assess sarcopenia using the 2019 criteria from the Asian Working Group for Sarcopenia. MHE was diagnosed through the Psychometric Hepatic Encephalopathy Score. Results Of the 210 cirrhotic patients (57.1% male, mean age 62.7 ± 9.6 years), 54 (25.7%) had sarcopenia, with 26 (12.3%) classified as severe. Thirty-seven patients (17.6%) were diagnosed with MHE. Sarcopenia prevalence was significantly higher in patients with MHE compared to those without MHE (45.9% vs. 21.4%). MHE was significantly associated with age, education level, Mini-Mental State Examination score, and a history of hepatic decompensation. No significant associations were found regarding gender, body mass index, comorbidities, sleep quality, and the etiology of cirrhosis. Multivariable logistic regression showed that MHE was significantly associated with age (adjusted odds ratio [aOR] 1.08, 95% CI 1.02–1.13), sarcopenia (aOR 3.29, 95% CI 1.44–7.50), history of overt hepatic encephalopathy (aOR 7.40, 95% CI 1.20-45.56), and variceal bleeding (aOR 3.13, 95% CI 1.38–7.10). Severe sarcopenia was also independently associated with MHE (aOR 3.64, 95% CI 1.32–10.05). Conclusions Sarcopenia is prevalent in cirrhotic patients and is associated with an increased risk of MHE. Our findings emphasize the importance of assessing sarcopenia to potentially mitigate MHE risk in managing patients with cirrhosis.https://doi.org/10.1186/s12876-025-03674-9CirrhosisHepatic decompensationMinimal hepatic encephalopathyPsychometric hepatic encephalopathy scoreSarcopenia
spellingShingle Wasit Wongtrakul
Wimolrak Bandidniyamanon
Phunchai Charatcharoenwitthaya
Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
BMC Gastroenterology
Cirrhosis
Hepatic decompensation
Minimal hepatic encephalopathy
Psychometric hepatic encephalopathy score
Sarcopenia
title Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
title_full Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
title_fullStr Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
title_full_unstemmed Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
title_short Relationship between Sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis: a prospective observational study
title_sort relationship between sarcopenia and minimal hepatic encephalopathy in patients with cirrhosis a prospective observational study
topic Cirrhosis
Hepatic decompensation
Minimal hepatic encephalopathy
Psychometric hepatic encephalopathy score
Sarcopenia
url https://doi.org/10.1186/s12876-025-03674-9
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