High Prevalence of Sarcopenia in Noncirrhotic Women With Primary Biliary Cholangitis: A Comparative Study of Clinical Characteristics and Risk Factors

Aim Sarcopenia is a common complication in patients with chronic liver disease (CLD). However, most prior studies on sarcopenia in CLD have predominantly focused on viral hepatitis and cirrhosis, with limited data available on its prevalence in primary biliary cholangitis (PBC), especially at noncirrhotic stages. This study is aimed at investigating the clinical characteristics and identifying independent risk factors for sarcopenia in female PBC patients. Methods We retrospectively enrolled 229 female patients, including 118 with chronic hepatitis B (CHB) and 111 with PBC. All patients underwent abdominal computed tomography (CT). The skeletal muscle area at the level of the third lumbar vertebra (L3) was measured using the image analysis software SliceOmatic V5.0 (TomoVision, Magog, Canada), and the skeletal muscle index (SMI) was calculated accordingly. Sarcopenia was defined based on the L3‐SMI index. We compared the prevalence of sarcopenia between PBC and CHB patients at different stages of liver fibrosis and further analyzed the clinical characteristics and independent risk factors for sarcopenia in PBC patients. Results Among the 229 female patients, 93 were noncirrhotic (45 with PBC and 48 with CHB). The prevalence of sarcopenia was significantly higher in noncirrhotic PBC patients than in noncirrhotic CHB patients (75.60% vs. 31.30%, χ 2 = 18.29, p < 0.001). Among the 136 cirrhotic patients (66 with PBC and 70 with CHB), sarcopenia prevalence showed no significant difference between PBC and CHB patients (60.60% vs. 52.90%, χ 2 = 0.83, p > 0.05). After propensity score matching (PSM), both cirrhotic and noncirrhotic PBC groups demonstrated a high prevalence of sarcopenia (85.30% vs. 70.60%, χ 2 = 2.138, p > 0.05). Multivariate analysis identified that low body mass index (BMI) (OR = 1.342; 95 % CI = 1.150–1.565; p < 0.001) and osteopenia/osteoporosis (OR = 4.2; 95 % CI = 1.408–12.533; p = 0.01) were independent risk factors for sarcopenia in female PBC patients. Conclusion Sarcopenia is highly prevalent in female PBC patients. In contrast to female CHB patients, in whom sarcopenia mainly occurs at the cirrhotic stage, female PBC patients exhibit high sarcopenia prevalence at both noncirrhotic and cirrhotic stages. Low BMI and osteopenia/osteoporosis are independent risk factors for sarcopenia in female PBC patients. Notably, sarcopenia should also be considered in PBC patients with normal or high BMI. Early and routine screening for sarcopenia and its risk factors is recommended in all PBC patients, regardless of cirrhosis stage.