Decoding the prognostic power of muscle strength in cirrhosis management

Cirrhosis, the final stage of various chronic liver diseases, remains a formidable global health challenge, claiming the lives of approximately one million people every year. With patients facing serious complications like malnutrition, muscle loss, and cognitive impairment, this progressive condition places a heavy burden on healthcare systems and families alike. Even as the global prevalence of cirrhosis continues to rise—affecting between 4.5% and 9.5% of populations in some countries— the need for better tools to predict patient outcomes and guide clinical care has never been more urgent.  

Currently, however, assessing the course of cirrhosis and identifying patients at high-risk can be complex, as doctors rely on invasive procedures or intricate scoring systems that are not always suitable for routine clinical use. Surprisingly, a simple test may hold the key to transforming patient care: handgrip strength (HGS) measurements. This non-invasive, cost-effective, and remarkably convenient method holds the potential to enhance how patients with or at risk of cirrhosis are managed.

In a recent comprehensive review, a research team led by Dr. Chao Sun from Tianjin Medical University General Hospital, China, conducted a comprehensive review of existing evidence on HGS’s role in cirrhosis care. Their findings were first made available online in Portal Hypertension & Cirrhosis on March 27, 2025, and published in Volume 4, Issue 2 of the journal on 22 June, 2025 highlights the strong prognostic value of HGS for people battling liver disease.

The researchers analyzed multiple studies demonstrating that reduced HGS is not merely a symptom, but a reliable predictor and indicator of many critical aspects of cirrhosis progression. For instance, HGS was strongly linked to a patient’s nutritional status, with lower scores often indicating malnutrition. It also proved effective in identifying sarcopenia, a condition characterized by significant muscle loss that can severely impact a patient’s quality of life and physical capabilities. Besides muscle health, HGS showed clear associations with physical function, such as walking speed and the risk of falls. Furthermore, the review highlighted HGS’s connection to bone health, serving as a valuable indicator of osteoporosis.

Perhaps most critically, the review highlighted the strong relationship between low HGS and more severe complications, including hepatic encephalopathy (HE)—a brain disorder caused by liver dysfunction—and overall mortality. Patients with reduced HGS consistently showed lower survival rates, with the measurement proving more sensitive than traditional muscle mass assessments. The underlying reason for this is the decline in muscle strength up to five times faster than muscle mass, making HGS tests an earlier indicator for worsening health. “Quantified HGS is pivotal, as early intervention is beneficial to mitigate the deterioration due to this advanced disease,” explains Dr. Sun.

Overall, existing literature suggests the HGS testing could become a key tool in cirrhosis management. By regularly assessing HGS, healthcare providers can gain crucial insights into a patient’s overall health trajectory, allowing for timely personalized interventions. For example, if a patient’s HGS begins to decline, doctors can recommend targeted nutritional support or specific exercise regimens aimed at building muscle strength. This proactive approach can help enhance patients’ quality of life and potentially improve their long-term outcomes.

Notably, HGS tests are quite straightforward to perform, as Dr. Sun notes, “The advantages of measuring HGS are that it is a simple, convenient, non-invasive, cost-effective, and easy to carry out method during daily clinical practice.” While further studies are needed to standardize HGS measurement protocols, this review offers compelling evidence that incorporating this straightforward tool into routine care could transform the prediction and management of cirrhosis-related complications.

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Reference
DOI: 10.1002/poh2.70006

About Dr. Chao Sun from Tianjin Medical University General Hospital
Dr. Chao Sun earned his bachelor’s degree from Peking University Health Science Center in 2008 and his MD and Ph.D. from Tianjin Medical University in 2014. He currently serves as Associate Chief Physician at the Department of Gastroenterology and Hepatology of Tianjin Medical University General Hospital. His research focuses on regulated cell death in liver injury and the prognostic roles of malnutrition, frailty, body composition, and trace elements in cirrhosis. He has published over 80 papers and presented at major conferences, besides serving as an editor for several peer-reviewed journals.