The relationship between sarcopenia,multidimensional frailty,and malnutrition cluster and long-term mortality in hospitalized patients with cirrhosis

Aim:Sarcopenia,multidimensional frailty,and malnutrition represent common debilitating conditions in the context of cirrhosis,linked to a variety of dismal outcomes.We aimed to clarify their overlap and cumulative impact on long-term mortality in hospitalized patients with cirrhosis.Methods:Consecutive patients with cirrhosis were prospectively recruited from January 2018 to December 2020.The diagnosis of sarcopenia,multidimensional frailty,and malnutrition was standardized according to the consensus definition and our well-documented criteria.The preva-lence of the respective debilitating condition and the concurrence of this comorbidity were calculated.Results:In total,253 patients with cirrhosis aged 64 years with a female predominance(52.4％)were recruited.Sarcopenia was present in 20.9％(53/253),multidimensional frailty in 12.6％(32/253),and malnutrition in 44.7％(113/253)of the entire cohort.Approximately half of the patients had at least one debilitating condition(127/253).Sarcopenia and malnutrition co-existed in 33 nonfrail patients(13.0％)and multi-dimensional frailty and malnutrition in eight nonsarcopenic patients(3.2％).Fifteen(5.9％)subjects had all three debilitating conditions,namely malnutrition,sarcopenia,and frailty(MSF)group.The propor-tions of males,infections,and ascites were significantly higher in the MSF group.Patients in the MSF group had the highest levels of neutrophil-to-lymphocyte ratio and creatinine.The 2-year mortality rates in patients with three debilitating conditions,two conditions,one condition,and no conditions were 60.0％,23.8％,21.4％,and 13.5％,respectively.Multivariate Cox regression indicated the long-term mortality risk was approximately four-fold higher among patients in the MSF group compared to those with no conditions.Conclusions:A fraction of patients with cirrhosis exhibited comorbidities of sarcopenia,multidimensional frailty,and malnutrition,linked to a higher risk of long-term mortality.