Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

Summary Background Recent advances in evaluation of body composition show body mass index to be inadequate in differentiating between body compartments in cirrhosis. Given the limitations of body mass index, body composition evaluation using computed tomography has been increasingly used as a non‐invasive clinical tool with prognostic value. Another factor influencing prognosis includes sex‐specific differences in body composition that are seen in cirrhosis. Aim To review current knowledge regarding the frequency and clinical implications of abnormal body composition features in cirrhosis. Methods We searched PubMed database and limited the literature search to full‐text papers published in English. Studies using inappropriate landmarks or demarcation of body composition components on computed tomography images were eliminated. Results Sarcopenia is a well established factor affecting morbidity and mortality in cirrhosis. Other important body composition components that have been overlooked thus far include subcutaneous adipose tissue and visceral adipose tissue. Female patients with cirrhosis and low subcutaneous adiposity have a higher risk of mortality, whereas male patients with high visceral adiposity have a higher risk of hepatocellular carcinoma and recurrence following liver transplantation. Increased adipose tissue radiodensity has been associated with risk of decompensation and mortality. Conclusions Further evaluation of body composition abnormalities may help with development of targeted therapeutic strategies and improve outcome in patients with cirrhosis. Moreover, recognition of these abnormalities could improve prioritisation for liver transplantation as our current method based solely on liver function might lead to risk misclassification.