Prevalence and Prognostic Impact of the Coexistence of Cachexia and Sarcopenia in Patients With Chronic Liver Diseases

BACKGROUND: Cachexia and sarcopenia are prevalent, inflammation-linked syndromes in chronic liver disease that worsen outcomes. To our knowledge, their coexistence in a single chronic liver disease cohort has not been systematically examined. In this study, we evaluated the prevalence, clinical features and prognostic impact of cachexia and sarcopenia-alone and combined-in chronic liver disease. METHODS: We retrospectively screened 776 patients with liver cirrhosis (LC) and/or hepatocellular carcinoma (HCC) at Hokkaido University Hospital (August 2014-May 2025). The inclusion criteria were grip strength, CT-based muscle mass and complete clinical data, yielding 307 patients; 469 did not meet one of the inclusion criteria. Cachexia was determined following the Asian Working Group for Cachexia criteria, and sarcopenia was determined following Japan Society of Hepatology guidelines. Patients were grouped as no cachexia/sarcopenia, cachexia only, sarcopenia only or cachexia+sarcopenia. The outcomes were overall survival, time to liver-related events and time to readmission (Kaplan-Meier and Cox-proportional models). RESULTS: Among 776 patients, 307 were included in the final-analysis. Of 307 patients, 206 (67.1%) were male, the median age was 70 years (range, 19-90 years), 262 patients (85.3%) had LC and 188 patients (61.2%) had HCC. The patients were grouped as no cachexia/sarcopenia (213; 69.4%), cachexia only (54; 17.6%), sarcopenia only (17; 5.5%) and cachexia+sarcopenia (23; 7.5%). The combined group compared with the others had the lowest body mass index, psoas-muscle-index and grip strength (all p < 0.001). Overall survival (OS), liver-related events, LC progression and readmissions were compared between 246 patients with and without cachexia or sarcopenia, after excluding those who visited the hospital on or after July 2023 and had ≤ 3 months of follow-up. OS was shorter in the cachexia only (median 61.8 95% CI 40.90-not reached (NR) months, p = 0.046) and cachexia+sarcopenia (median 59.6 95% CI 14.26-NR months, p = 0.027) groups than in the no cachexia/sarcopenia group. Multivariable analysis showed that cachexia+sarcopenia (hazard ratio 2.48, p = 0.010), HCC (hazard ratio 3.40, p < 0.001) and diabetes mellitus (hazard ratio 1.80, p = 0.013) independently predicted mortality. The combined group compared with the other groups had a shorter time to liver-related events and readmission. CONCLUSIONS: The coexistence of cachexia and sarcopenia-rather than either alone-can be used as an indicator for identifying patients with chronic liver disease at the highest risk of poor outcomes. Concurrent assessment and early, targeted interventions may improve outcomes in this population.