Phase Angle/C-reactive Protein-Index as a Novel Combined Tool for Predicting Liver-Related Hospitalizations in MASLD-Decompensated Cirrhosis

Background

Phase angle (PA), a bioelectrical impedance analysis (BIA)-assessable marker of sarcopenia, can accurately predict hospitalizations in advanced chronic liver disease (ACLD). PA has never been specifically investigated in metabolic dysfunction-associated steatotic liver disease (MASLD). Sarcopenia is commonly observed in patients with MASLD, whereas individuals with compensated ACLD (cACLD)-MASLD progress more rapidly to decompensated ACLD (dACLD).

Aims

To evaluate the PA values across the different stages of liver disease progression in MASLD, and to estimate the accuracy of the novel PA/C-reactive-protein (CRP) index (PAC-I) in predicting 3 month further liver-related events (LREs) and hospitalizations in MASLD-dACLD.

Methods

Patients with MASLD were consecutively enrolled and stratified according to liver stiffness measurement (LSM) and eventual previous LREs in ≤F3 fibrosis (AF), cACLD, and dACLD. At baseline, anthropobiochemical, nutritional, and clinical data were collected. Patients with MASLD-dACLD were followed up, and further LRE-determining hospitalizations within the subsequent three months were recorded.

Results

In patients with MASLD, PA values were inversely correlated with LSM, and progressively decreased according to the worsening of liver disease (cACLD vs. dACLD, p <0.0001). In patients with dACLD, PA inversely correlated with CRP levels. PAC-I showed greater accuracy and superiority compared to PA alone in predicting the occurrence of further LREs within three months (PAC-I <2.35: optimal cut-off). Consistently, patients with dACLD with PAC-I <2.35 presented a higher risk of further LREs.

Conclusions

In MASLD, PA correlates with disease progression status. PAC-I represents a useful noninvasive tool in predicting short-term liver-related hospitalizations in dACLD.