SAT-848 - Assessment of Sarcopenia using Handgrip Strength Testing in A Cirrhotic Cohort: A Prospective Quality Improvement Study

Background:
Patients with cirrhosis are at increased risk of sarcopenia, a condition associated with functional decline, increased morbidity, and mortality. Hand grip strength (HGS) testing is a reliable, simple, and noninvasive screening tool for sarcopenia. This quality improvement project aimed to implement routine HGS testing in a gastroenterology (GI) clinic at the University of Kansas–Wichita to improve sarcopenia detection, monitor muscle strength progression over time, and enhance patient engagement and quality of life.

Methods:
Adult patients with cirrhosis undergoing evaluation in our clinic were screened using standardized HGS testing beginning January 2025, which was implemented into the clinic workflow as part of the patients' vitals checks . Demographic, clinical, and laboratory data including MELD-3 scores and decompensation status were collected. Sarcopenia was defined using established age and sex-adjusted HGS cutoffs. Feasibility and patient experience were assessed using a post-testing survey. Baseline sarcopenia prevalence and associations with clinical characteristics were analyzed. In a subset, longitudinal changes in HGS and MELD-3 scores at 3 and 6 months were evaluated.

Results:
A total of 137 patients underwent HGS testing. Mean age was 60.4±12.3 years, 54.7% were female, and mean BMI was 30.9±6.4 kg/m². Alcohol-associated liver disease (38.7%) and MASLD/MASH (35.0%) were the most common etiologies. Prior hepatic decompensation was present in 80.3%, and 52.6% were currently decompensated. Mean baseline MELD-3 score was 11.4±4.7. Baseline sarcopenia was identified in 16.8% (95% CI 11.4–24.1). Sarcopenia’s prevalence was higher among patients with prior decompensation (19.1% vs 7.4%) and current decompensation (22.2% vs 10.8%), though differences were not statistically significant. Sarcopenic patients were younger (53.1±12.1 vs 61.9±11.9 years, p=0.002) and had higher MELD-3 scores (14.3±6.2 vs 10.7±4.0, p=0.001). Mean baseline HGS was significantly lower in sarcopenic patients (35.9±13.2 vs 61.1±21.0 lbs, p< 0.001). Among surveyed patients (n=50), 98% understood the test and its relevance, 94% reported no discomfort, and 96% were willing to repeat testing. Mean satisfaction score was 4.78/5. HGS testing required approximately 4 minutes and did not delay clinic flow.

Conclusion:
Routine HGS testing is feasible, well accepted by patients, and identifies sarcopenia in a substantial proportion of ambulatory patients with cirrhosis. HGS association with greater disease severity and ability to detect sarcopenia as well as monitor muscle strength progression in at-risk populations supports its’ incorporation not only into outpatient cirrhosis care but also potentially Endocrinology, Primary Care, and dietitian practices to enhance risk stratification, nutritional and rehabilitation interventions, and patient quality of life.

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