Using Serum Creatinine‐to‐Cystatin C Ratio to Predict Sarcopenia in Patients With Liver Cirrhosis

ABSTRACT Aim The creatinine‐to‐cystatin C ratio (CCR) is considered a convenient surrogate marker for muscle mass, although its evidence in cirrhotic populations is limited. This study investigated the significance of CCR as a marker of sarcopenia in patients with cirrhosis. Methods Handgrip strength (HGS) and skeletal muscle mass index (SMI) were assessed in 195 patients with cirrhosis, divided into the sarcopenia ( n = 70) and nonsarcopenia ( n = 125) groups. Risk factors associated with sarcopenia were identified through multivariable logistic regression analyses. Results Sarcopenia was diagnosed in 70 out of 195 patients (35.9%). Patients with sarcopenia were significantly older, with lower body mass index (BMI), serum creatinine, and CCR, as well as higher albumin–bilirubin scores. Age ≥ 65 years, BMI < 25, and low CCR (< 0.63 in women, < 0.68 in men) were independently associated with sarcopenia on both univariable and multivariable analyses. The predictive accuracy of CCR for sarcopenia was comparable to that of a multivariable model combining age and BMI. On Kaplan–Meier analysis, overall survival was significantly lower in patients with low CCR (< 0.66) versus those with high CCR (≥ 0.66). Furthermore, HGS, SMI, and sarcopenia had comparable diagnostic value. Conclusions CCR is a simple, noninvasive biomarker for the diagnosis and prognosis of sarcopenia in patients with LC.