The impact of sarcopenia and frailty on decompensation in compensated cirrhosis: A systematic review

Background: Sarcopenia and frailty have a negative prognostic impact in patients with decompensated cirrhosis; however, the impact of these conditions on the prognosis of compensated cirrhosis is unknown. We performed a systematic review to assess the effect of sarcopenia and frailty on decompensation in patients with compensated cirrhosis. Methods: We searched PubMed and Embase for English-language studies published up to April 2025. The primary outcome was decompensation and the secondary outcome was mortality. We included studies with available data on patients with compensated cirrhosis. Results: Eight studies reporting data on sarcopenia (n=829 patients) and 4 studies (n=552 patients) assessing frailty were included in this systematic review. The prevalence of sarcopenia varied from 8% to 63%. Computed tomography at the L3 level and liver frailty index were the methods most commonly used to evaluate sarcopenia and frailty, respectively. Sarcopenia in patients compensated at inclusion was associated with an increased risk of decompensation in some studies, but not in all. When selected patients with compensated cirrhosis and no previous decompensation were studied, most studies showed no increased risk for first decompensation within the follow-up (12–61 mo). Two studies out of the 4 reported a higher risk of decompensation and mortality in patients with frailty. Conclusions: We reported that sarcopenia was prevalent in patients with compensated cirrhosis, but, in most studies, did not lead to an independent, increased risk of first decompensation and death. Well-designed, prospective multicenter studies are essential to assess the association between sarcopenia, frailty, and the risk of first decompensation.