Sarcopenia in Chronic Liver Disease: The Emerging Role of Ultrasound in Determining Muscle Mass, Strength and Clinical Outcomes

Our reseach highlights the role of ultrasound as a reliable tool for assessing sarcopenia in patients with chronic liver disease. Notably, indices derived from quadriceps measurements have demonstrated superior diagnostic accuracy and reproducibility, supporting the use of ultrasound as an effective screening test in clinical practice. However, the heterogeneity of the existing literature, the small sample sizes, and the lack of external validation necessitate further studies on larger and more diverse cohorts to establish ultrasound as a standard diagnostic tool for early sarcopenia detection and risk stratification in both cirrhotic patients and those with hepatocellular carcinoma. Similarly, the present study underscores the prognostic significance of dynapenia in patients with chronic liver disease, independently of liver-disease severity. Muscle strength—assessed through hand-grip strength and possibly diaphragmatic excursion—appeared to be a more sensitive predictor of mortality than muscle mass in specific at-risk populations. These findings emphasize the need to integrate muscle-strength assessment into the clinical management of sarcopenia. Finally, our pilot study with Hydroxiram-D supplementation also sheds light on the role of nutritional support in improving or preserving muscle function and mass, counteracting the development of sarcopenia. Larger, adequately powered trials are eagerly awaited to confirm its efficacy and long-term benefits in this population. In addition, future research should aim to explore the impact of myosteatosis and longitudinal changes in muscle function.