Prevalence, association, and prognostic significance of polypharmacy and sarcopenia in patients with liver cirrhosis

Tatsunori Hanai; Kayoko Nishimura; Takao Miwa; Toshihide Maeda; Kenji Imai; Atsushi Suetsugu; Koji Takai; Masahito Shimizu

doi:10.1002/jgh3.12877

Prevalence, association, and prognostic significance of polypharmacy and sarcopenia in patients with liver cirrhosis

JGH Open. 2023 Feb 12;7(3):208-214. doi: 10.1002/jgh3.12877. eCollection 2023 Mar.

Authors

Tatsunori Hanai¹, Kayoko Nishimura², Takao Miwa¹, Toshihide Maeda¹, Kenji Imai¹, Atsushi Suetsugu¹, Koji Takai¹, Masahito Shimizu¹

Affiliations

¹ Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan.
² Center for Nutrition Support and Infection Control Gifu University Hospital Gifu Japan.

Abstract

Background and aim: Polypharmacy and sarcopenia are increasing public health problems worldwide. However, data on the prevalence, association, and prognostic significance of polypharmacy and sarcopenia in patients with liver cirrhosis are limited.

Methods: Polypharmacy and sarcopenia were assessed in 239 patients with liver cirrhosis. Polypharmacy was defined as the daily use of six or more medications, and sarcopenia was diagnosed based on muscle strength and mass evaluated on computed tomography. The association between polypharmacy and sarcopenia and their effects on mortality were analyzed using logistic regression and Cox proportional hazards models.

Results: Among the 239 patients, 52% were men, the median age was 68 years, and the number of medications used per patient was 6. Further, 53% and 29% patients had polypharmacy and sarcopenia, respectively. The number of medications used and the prevalence of sarcopenia increased with age. Patients with polypharmacy and sarcopenia had similar characteristics, such as older age, increased medication use, advanced liver disease, and decreased muscle strength and mass. After adjusting for confounders, polypharmacy was significantly associated with sarcopenia (odds ratio, 2.11; 95% confidence interval [CI], 1.07-4.17). During the median follow-up of 2.2 years, 62 (26%) patients died. Polypharmacy (hazard ratio [HR], 1.83; 95% CI, 1.01-3.37) and sarcopenia (HR, 2.00; 95% CI, 1.12-3.50) independently predicted mortality. The prognostic significance of polypharmacy was more prominent in older adults than in younger adults (HR, 2.31; 95% CI, 1.01-5.67).

Conclusion: Polypharmacy and sarcopenia are interrelated and associated with poor prognosis in patients with cirrhosis. Further large, prospective, population-based studies are required to validate these findings.

Keywords: cirrhosis; multimorbidity; older adults; polypharmacy; sarcopenia.