Assessment of Sarcopenia Using Muscle Ultrasound in Patients With Cirrhosis and Sarcopenic Obesity (AMUSE STUDY)

Background and Aims:Sarcopenic obesity (SO) marks a confluence of 2 complex entities involving the muscle-liver-adipose tissue axis. Computed tomographic (CT) scan-derived skeletal muscle index (SMI) remains the gold standard for sarcopenia assessment in SO. However, it has intrinsic limitations of cost, radiation, and point of care applicability. We assessed the role of muscle ultrasound (US) in SO. Methods:A total of 52 patients with cirrhosis and obesity were assessed for sarcopenia using SMI. US assessment of thigh and forearm muscles was done to record quadriceps muscle thickness (QMT), quadriceps feather index (QMFI), forearm muscle thickness (FMT), and forearm feather index (FFI), respectively. Evaluated US parameters were correlated with SMI and assessed for diagnostic accuracy using the area under the curve. Results:A total of 40 (76.9%) males and 12 (23.1%) females [mean age: 50.9 y (43.8 to 53.5 y)] were included. QMT [0.45 cm/m(2) (0.42 to 0.48 cm/m(2)) vs. 0.67 cm/m(2) (0.63 to 0.70 cm/m(2))], QMFI [0.82 cm/m(2) (0.77 to 0.87 cm/m(2)) vs. 1.12 cm/m(2) (1.06 to 1.19 cm/m(2))], FMT [0.19 cm/m(2) (0.17 to 0.20 cm/m(2)) vs. 0.25 cm/m(2) (0.23 to 0.27 cm/m(2))], and FFI [0.38 cm/m(2) (0.35 to 0.412 cm/m(2)) vs. 0.47 cm/m(2) (0.44 to 0.50 cm/m(2))] were significantly lower in patients with SO (P<0.01). A positive correlation with SMI was seen for all parameters in the entire cohort. The strongest correlation was exhibited by QMT (r=0.70) and QMFI (r=0.70) in males. The area under the curve of QMT, QMFI, FMT, and FFI were 0.98 (95% confidence interval: 0.96-1), 0.95 (0.89-1), 0.85 (0.75-0.96), and 0.80 (0.68-0.93), respectively. Conclusions:US-based assessment of sarcopenia has excellent diagnostic accuracy and correlates well with computed tomography-SMI in patients with SO. US may serve as an easy-to-use, point of care tool for assessing sarcopenia in SO with the advantage of repeated sequential assessment.