Sarcopenia is common among patients with cirrhosis and is closely associated with poor prognosis. However, the value of different methods for assessing sarcopenia in predicting mortality risk in patients with cirrhosis remains controversial. This study aims to systematically evaluate the predictive ability of different methods for measuring sarcopenia regarding mortality risk in patients with cirrhosis.

A systematic search was conducted in PubMed, Web of Science, and the Cochrane Library to identify studies evaluating the association between sarcopenia and the risk of mortality in patients with cirrhosis. The primary outcome measures were the hazard ratio (HR) and its 95% confidence interval. A meta-analysis was performed using a random-effects model, and subgroup analyses were conducted based on different assessment methods, including computed tomography (CT) imaging, handgrip strength (HGS), ultrasound (US), and dual-energy X-ray absorptiometry (DXA).

A total of 15 studies were included. The overall meta-analysis results showed that sarcopenia significantly increased the risk of mortality in patients with cirrhosis. In the CT assessment group, the overall pooled HR was 2.06 (95% CI: 1.65–2.57). Subgroup analysis showed that the HR in the Skeletal Muscle Index (SMI) group was 1.88 (95% CI: 1.50–2.36), the Psoas Muscle Index/Psoas Muscle Thickness/Transverse Psoas Muscle Thickness (PMI/PMT/TPMT) group had an HR of 3.19 (95% CI: 1.62–6.28). The Handgrip Strength (HGS) group had an HR of 2.21 (95% CI: 1.61–3.05), suggesting a significant association between reduced handgrip strength and mortality risk. The HR for the US group was 0.94 (95% CI: 0.64–1.40), which did not reach statistical significance. The HR for the DXA group was 0.69 (95% CI: 0.50–0.95). There were some differences in predictive ability among the different assessment methods.

 Sarcopenia is a significant predictor of mortality in patients with cirrhosis. CT-based imaging assessments and grip strength measurements demonstrate good clinical value in predicting mortality in patients with cirrhosis, whereas ultrasound measurements of muscle thickness have relatively limited predictive ability. Future studies should establish standardized criteria for assessing sarcopenia to improve the accuracy of prognostic evaluations in patients with cirrhosis.