Sarcopenia is an increasingly recognized complication of cirrhosis that is associated with morbidity and mortality. Differences in the prevalence and prognosis of sarcopenia between men and women have been reported in other patient groups, but there is insufficient understanding of how sex impacts the prognostic value of sarcopenia in cirrhosis. A search of MEDLINE and Embase was conducted from earliest entries to April 2021. Studies were included if they examined sex-stratified mortality impact of reduced muscle function or mass in outpatient populations with cirrhosis. We identified 700 studies of which 6 were deemed relevant for inclusion in this narrative review. Studies of interest were heterogeneous, precluding pooling of data and making interpretation of the literature challenging. Muscle mass was assessed in five studies (n = 2566, 1730 men, 836 women) and was reduced in 36–50% of men and 24–43% of women. All five studies found that reduced muscle mass determined by computed tomography, dual-energy X-ray absorptiometry, and bioelectrical impedance analysis was associated with increased mortality in men. Of these, two studies identified a corresponding relationship in women; reduced muscle mass defined by computed tomography was associated with increased mortality [hazard ratio (HR) 2.82, P = 0.001], while increasing muscle mass by bioelectrical impedance analysis likewise conferred a survival benefit (HR 0.45, P = 0.0016). Only one study assessed the relationship of muscle function with sex-stratified mortality (n = 1405, 827 men, 578 women), concluding that reduced muscle function predicted mortality in both men and women (HR 1.65, P < 0.001 and HR 1.54, P < 0.001, respectively). Reduced muscle mass in cirrhosis is consistently associated with mortality in men, but lack of sex-stratification of mortality analyses limits the ability to make strong conclusions about the impact of sarcopenia specifically in women, with even fewer data available for analysing muscle function. Improved understanding of the sex-specific impacts of sarcopenia may help address patient deterioration and mortality while awaiting liver transplantation and allow for early intervention to mitigate mortality risk. Large, multicentre studies with adequate female participation and sex-stratified mortality analyses are warranted.

中文翻译：

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肌肉减少症在肝硬化中的性别特异性预后效用

肌肉减少症是一种越来越被认可的肝硬化并发症，与发病率和死亡率有关。男性和女性肌肉减少症的患病率和预后在其他患者群体中存在差异，但对性别如何影响肝硬化肌肉减少症的预后价值了解不足。从最早的条目到 2021 年 4 月对 MEDLINE 和 Embase 进行了搜索。如果他们检查了门诊肝硬化患者肌肉功能或质量下降对性别分层死亡率的影响，则研究被包括在内。我们确定了 700 项研究，其中 6 项被认为与纳入该叙述性综述相关。感兴趣的研究是异质的，排除了数据的汇集并使文献的解释具有挑战性。五项研究评估了肌肉质量（n  = 2566，男性 1730 人，女性 836 人），男性减少 36-50%，女性减少 24-43%。所有五项研究都发现，通过计算机断层扫描、双能 X 射线吸收测定法和生物电阻抗分析确定的肌肉量减少与男性死亡率增加有关。其中，两项研究确定了女性的对应关系；计算机断层扫描定义的肌肉质量减少与死亡率增加相关 [风险比 (HR) 2.82，P  = 0.001]，而通过生物电阻抗分析增加肌肉质量同样带来生存益处（HR 0.45，P  = 0.0016）。只有一项研究评估了肌肉功能与性别分层死亡率之间的关系（n = 1405，827 名男性，578 名女性），结论是肌肉功能下降预测男性和女性的死亡率（HR 1.65，P  < 0.001 和 HR 1.54，P < 0.001，分别）。肝硬化引起的肌肉量减少始终与男性死亡率相关，但缺乏死亡率分析的性别分层限制了就肌肉减少症特别是对女性的影响得出强有力结论的能力，可用于分析肌肉功能的数据甚至更少。更好地了解肌肉减少症的性别特异性影响可能有助于解决患者在等待肝移植期间病情恶化和死亡的问题，并允许进行早期干预以降低死亡风险。有足够女性参与的大型、多中心研究和性别分层死亡率分析是必要的。