Frailty and Sarcopenia in Cirrhosis: Current Knowledge and Future Directions

Abstract

Purpose of the review: This narrative review aims to update current knowledge about frailty, sarcopenia, and their interplay, highlight gaps in the literature. Recent findings: Sarcopenia involves loss of skeletal muscle mass, while frailty reflects broader functional decline, including muscle strength impairment. These conditions are interrelated, but distinct and poor correlation between them has been reported. Research on sarcopenia and frailty in acute-on-chronic liver failure (ACLF) and hepatocellular carcinoma (HCC) highlights their prognostic significance, though findings are heterogeneous. Sex oriented analysis is needed to clarify different impacts on outcome. Summary: End-stage liver disease increases the risk of sarcopenia and frailty particularly in advanced cases. CT-based skeletal muscle index is the gold standard for sarcopenia diagnosis, while ultrasound offers potential for outpatient use. Frailty is increasingly recognized as a critical predictor of survival both pre- and post-liver transplantation. Emerging therapies, including nutrition, exercise, and pharmacology, show potential but need validation. Future research should prioritize standardized assessments and personalized interventions to improve outcomes.