The liver frailty index is a good reflection of muscle function and identifies increased frailty in patients with non-cirrhotc steatotic liver disease compared with healthy controls

Henin, Guillaume [UCL] Goffaux, Alexis [UCL] Declerck, Salomé [UCL] André-Dumont, Stéphanie [UCL] Pendeville, Etienne [UCL] Valet, Maxime [UCL] Lejeune, Thierry [UCL] Dahlqvist, Géraldine [UCL] Loumaye, Audrey [UCL] Starkel, Peter [UCL] Lanthier, Nicolas [UCL]

The liver frailty index is a good reflection of muscle function and identifies increased frailty in patients with non-cirrhotic steatotic liver disease compared with healthy controls Guillaume Henin1;2 , Alexis Goffaux1 , Salomé Declerck1 , Stéphanie André-Dumont1 , Etienne Pendeville3 , Maxime Valet4;5 , Thierry Lejeune6 , Géraldine Dahlqvist2 , Audrey Loumaye7 , Peter Stärkel1;2 , Nicolas Lanthier1;8 1 laboratoire de gastroentérologie et d'hépatologie (GAEN), institut de recherche expérimentale et clinique, UCLouvain, Brussels, Belgium, 2service d'hépato-gastroentérologie, Cliniques universitaires saint-Luc, UCLouvain, Brussels, Belgium, 3Service de kinésithérapie et ergothérapie, Cliniques universitaires saint-Luc, UCLouvain, Brussels, Belgium, 4Neuro Muscular Skeletal Lab (NMSK), institut de recherche expérimentale et cliniques, UCLouvain, Brussels, Belgium, 5Service de médecine physique et réadaptation, Grand hôpital de Charleroi, charleroi, Belgium, 6service de médecine physique et réadaptation, Cliniques universitaires saint-Luc, Brussels, Belgium, 7service d'endocrinologie, diabétologie et nutrition, Cliniques universitaires saint-Luc, UCLouvain, Brussels, Belgium, 8service d'hépato-gastroentérologie, Cliniques universitaires saint-Luc, UCLouvain, brussels, Belgium Email: guillaume.henin@uclouvain.be Background and Aims: Muscle function decay and frailty are prevalent in cirrhosis whatever the cause. However, muscle function evaluation in non-cirrhotic patients are lacking, as well as data by etiology, including steatotic liver diseases (SLD). Our aim is to determine if muscle function already decays in non-cirrhotic SLD and if the SLD subtype impacts muscle function. Method: SLD patients were prospectively recruited and classified according to the recent SLD subtype categories. Liver disease was assessed by transient elastography (Fibroscan®). Cirrhotic patients were excluded. Controls were defined by the absence of liver steatosis on controlled attenuation parameter (< 215 dB/m). Muscle function was assessed by isokinetic dynamometer (Cybex®). All patients and controls also underwent the three tests used to calculate the liver frailty index (LFI): handgrip strength, sit-to-stand test and balance test. SLD patients and controls were classified based on the LFI as robust (LFI < 3) or pre-frail/frail (LFI ≥ 3). Results are expressed as means ± SD. Results: One-hundred and thirty-seven patients with SLD were included: 69 with alcohol-related liver disease (ALD) and 66 with metabolic dysfunction-associated steatotic liver disease (MASLD). Thirty healthy participants matched for sex and age (controls: 47.8 years ± 14.1, ALD: 50.2 ± 10.8, MASLD: 52.5 ± 10.4; p = 0.16) were used as controls. However, the groups differed for several parameters, such as alanine aminotransferase (controls: 18.4 IU/L ± 10.2, ALD: 74.8 ± 53.2, MASLD: 48.3 ± 29.5; p < 0.0001), liver stiffness (controls: 4.4 kPa ± 1, ALD: 8.9 ± 3.5, MASLD: 9 ± 3.9; p < 0.0001) and body mass index (controls: 22.1 kg/m² ± 2, ALD: 26.3 ± 5, MASLD: 33.3 ± 6.4; p < 0.0001). LFI was higher in all SLD subgroups compared to controls (controls: 2.2 ± 0.8, ALD: 3.2 ± 0.8, MASLD 3.1 ± 0.7; p < 0.0001) without any difference between MASLD and ALD patients (p = 0.67). 56.5 of ALD patients and 58.5 % of MASLD patients were considered pre-frail or frail (p = 0.81) compared to only 10 % of control patients (p < 0.0001). LFI negatively correlated with right knee extension evaluated by isokinetic dynamometer in all SLD patients (N = 137, r = -0.53; p < 0.0001). Conclusion: LFI is an accurate method to assess muscle function in non-cirrhotic SLD patients. Muscle function assessed by the LFI decays compared to age-matched non-SLD controls. Frailty is not influenced by the SLD subtype. This reinforces the concept of a muscle-liver axis already in the early stages of SLD.