Prevalence of sarcopenia and its correlation with splenic stiffness in non-cirrhotic portal hypertension

Background and Aim: Sarcopenia is common in cirrhosis and has been reported to be an independent predictor of morbidity and mortality. However, there is little information on its prevalence and clinical importance in non-cirrhotic portal hypertension (NCPH). Hence, we undertook this study to determine the frequency of sarcopenia in south Indian patients with NCPH and its association with splenic stiffness and clinical outcome. Methods: It was a cross sectional analytical study conducted over a period of 2 months including 40 consecutive patients with NCPH who were compared with 50 consecutive patients with cirrhosis. Muscle strength was measured using a handheld dynamometer to screen for sarcopenia which was defined based on INASL 2020 consensus. Splenic stiffness (SSM) was measured by ARFI elastography. Descriptive and inferential statistics was used to analyse the data. The correlation between sarcopenia and SSM was determined using Spearman’s correlation. Results: Out of 40 cases of NCPH studied, 31 were women and 9 were men with a mean age of 38.85 ±9.6 years and mean disease duration of 3.5 years. Sarcopenia was present in 13 (33%) patients with NCPH and 33 (66 %) patients with cirrhosis (P=0.01). There was a positive correlation (r=0.209, P=0.2) between SSM and sarcopenia, with higher SSM observed in NCPH patients with sarcopenia (mean: 4.26 vs. 3.96) (P=0.05). Variceal bleeding was also more commonly seen in NCPH who had sarcopenia (69% vs 44%, P=0.07). Mean SSM was higher in those with varices needing therapy (VNT) than low-risk varices (4.16 m/s vs 3.9 m/s, P= 0.09) Conclusions: Sarcopenia was prevalent in one-third of patients with NCPH which was significantly lower compared to cirrhosis. Splenic stiffness by elastography was higher in NCPH patients with sarcopenia.