Geriatric Nutritional Risk Index as a Predictor of Sarcopenia in Egyptian Patients with Viral Hepatitis-Related Liver Cirrhosis.

Abstract

Background: Sarcopenia is a prevalent yet underdiagnosed complication in elderly patients with liver cirrhosis, associated with poor outcomes and increased frailty. In low-resource settings, the use of advanced imaging techniques for sarcopenia assessment is often limited. The Geriatric Nutritional Risk Index (GNRI) is a simple tool that may serve as a surrogate marker for sarcopenia, particularly in high-risk populations such as elderly cirrhotic patients with viral hepatitis. Objective: To evaluate the clinical utility of the GNRI in predicting sarcopenia and its severity in elderly Egyptian patients with viral hepatitis-related liver cirrhosis, and to explore its correlations with liver function scores and physical performance indices. Methods: This cross-sectional study included 90 elderly patients (aged ≥ 60 years) with viral hepatitis-related cirrhosis. Sarcopenia was diagnosed and staged according to EWGSOP2 criteria, incorporating measurements of muscle strength (handgrip), muscle mass (calf circumference), and physical performance (gait speed, KATZ index). GNRI was calculated using serum albumin and body weight. Liver disease severity was assessed using Child-Pugh and ALBI scores. Correlations between GNRI, sarcopenia components, and liver scores were analyzed, and diagnostic accuracy of GNRI and Child score in predicting severe sarcopenia was evaluated. Results: The prevalence of sarcopenia in the cohort was 95.5%, with 42.2% classified as having severe sarcopenia. GNRI showed significant positive correlations with muscle strength (r = 0.536, p < 0.001), gait speed (r = 0.377, p = 0.001), and negative correlations with Child score (r = -0.240, p = 0.023) and ALBI score (r = -0.380, p < 0.001). A GNRI ≤ 87 was identified as an independent predictor of severe sarcopenia (OR = 4.15, p = 0.011). GNRI demonstrated high specificity (100%) but limited sensitivity (24.4%) for severe sarcopenia (AUC = 0.658). Conclusions: GNRI is a practical and cost-effective tool for predicting sarcopenia and functional decline in elderly patients with viral hepatitis-related liver cirrhosis. Its integration with functional performance assessments offers a comprehensive approach for early detection and risk stratification. GNRI may serve as a valuable screening tool, particularly in resource-limited hepatology settings.