Dynamic Changes in Visceral Fat Density and Skeletal Muscle Index Predict New-onset Decompensation in Chronic Hepatitis B-Related Cirrhosis

Background & Aims The occurrence of decompensation events in patients with cirrhosis is a critical determinant of adverse prognosis, yet their accurate prediction remains clinically challenging. This study evaluated the predictive value of metabolic status, body composition (fat and muscle mass), and their longitudinal changes for decompensation risk across different disease stages in chronic hepatitis B (CHB)-related cirrhosis. Methods A total of 68 patients with CHB-related cirrhosis were enrolled. Standard logistic or Cox regression models were applied for all univariate analyses, while both standard and Firth-corrected models were used in multivariate analyses. In cross-sectional analysis, ROC curves were adopted to assess the discriminatory ability of significant variables for decompensation at enrollment. In longitudinal analysis, Kaplan–Meier analysis and time-dependent ROC curves were used to verify the predictive value of significant predictors for new-onset decompensation. Results Visceral fat density (VFD) was relatively better than high-density lipoprotein (HDL) in discriminating decompensation events in CHB-related cirrhosis (AUC = 0.665 vs AUC = 0.574). The rate of change in VFD (p = 0.004) was an independent predictor for new-onset decompensation in patients with compensated cirrhosis. In the decompensated group, only the rate of change in skeletal muscle index (SMI) (p = 0.039) showed a significant association in univariate analysis. Increasing VFD ( p < 0.001) and decreasing SMI ( p = 0.016) values correlated with worse event-free survival (from enrollment to new-onset decompensation) in the compensated and decompensated groups, respectively. Time-dependent ROC indicated moderate predictive performance of VFD change in compensated patients and modest performance of SMI change in decompensated patients. Conclusions VFD demonstrated relatively better discriminative capacity compared with HDL levels for identifying decompensation events in CHB-related cirrhosis. Increasing VFD and decreasing SMI values may act as potential stage-specific predictors of new-onset decompensation events in the compensated and decompensated phases, respectively.