Bioimpedance Analysis to Predict Clinical Outcomes of Liver Cirrhosis in a Prospective Cohort Study

Background and Aims Bioimpedance analysis (BIA) is a non‐invasive method for estimating body composition, which plays a role in the development of cirrhosis. We investigated if BIA measures were associated with cirrhosis complications. Methods We analyzed data from 566 participants in a prospective cohort study of cirrhosis patients from tertiary care clinics who underwent BIA at enrollment and regular follow up (20.3% female; 47.0% non‐Hispanic White, 23.1% Hispanic, 27.7% Black; 47.7% metabolic and alcohol‐associated liver disease [MetALD], 30.4% metabolic dysfunction‐associated steatotic liver disease [MASLD], 1.9% alcohol‐associated liver disease [ALD], 9.0% active hepatitis C virus [HCV]). We performed multivariable logistic regression to assess the association of BIA measures with etiology and prevalent decompensation and Cox proportional hazards regression to assess incident decompensation and HCC. Results After adjustment for sex and race, body fat mass was associated with 14‐fold increased odds of MASLD (adjusted odds ratio [aOR] 14.10, 95% confidence interval [CI] 5.25–37.85) and decreased odds of ALD (aOR 0.73, 95% CI 0.60–0.88). Lower odds of prevalent decompensation were seen in the highest tertile of trunk lean mass (aOR 0.39, 95% CI 0.21–0.73) and left arm lean mass (aOR 0.40, 95% CI 0.21–0.75) compared with their lowest tertiles. The middle tertile of visceral fat surface area showed an inverse association with incident decompensation (adjusted hazard ratio 0.19, 95% CI 0.04–0.88). There were no significant associations between BIA measures and incident HCC. Conclusions BIA could be used as a prognostic tool for patients with cirrhosis, supporting its incorporation into clinical workflows.