Frailty, sarcopenia and mortality in cirrhosis: what is the best assessment, how to interpret the data correctly and what interventions are possible?

Cirrhosis-induced sarcopenia plays a deleterious role in patients on the waiting list of transplantation. Liver frailty index (LFI) calculation based on easy measurable clinical parameters (muscle strength and balance data) seems therefore accurate for identifying patients at risk for waiting list mortality. However, some questions remain open such as the difficult clinical testing of patients with encephalopathy, the comparison of these clinical data with the radiological evaluation of muscle quantity and quality, the attitude to adopt towards these patients identified as fragile (emergency versus futile transplantation?) and the possible benefit of interventions (nutrition and/or exercise). Finally, recent data show that the deterioration of the muscle condition occurs early prior to the development of advanced fibrosis (specifically in fatty liver disease). This underlines the interest of evaluating the muscle compartment during the pathogenesis of liver diseases, also before the emergence of cirrhosis.