Volume 88 - 2025 - Fasc.1 - Reviews
Knee extension strength in patients with liver cirrhosis and the impact of interventions: systematic review and meta-analysis
Background: Sarcopenia is common in patients with cirrhosis
and lower limb muscle strength could represent a factor of
morbidity. A systematic review with meta-analysis on knee
extension muscle strength in patients with cirrhosis was performed.
Methods: Literature was reviewed in electronic databases from
inception until March 2023. Two independent researchers applied
the inclusion criteria to assess the eligibility of articles. Of the 28
retrieved articles; 21 of them met the eligibility requirements.
Results: Muscle strength was impaired in patients with cirrhosis
versus age-matched control (standardized mean difference, SMD:
3.48, 95% CI 2.35–4.61, I² = 96.5%, p<0.001) and was negatively
influenced by increasing disease severity, with Child-Pugh A and B
superior to C (SMD: 2.62, 95% CI 0.54–4.71, p<0.014; SMD 0.71,
95% CI 0.29–1.13, p<0.001, respectively). Exercise training tended
to increase (SMD: 1.21, 95% CI 0.16-2.59, p=0.085), while liver
transplantation decreased knee extension strength (SMD: -0.45,
95% CI -0.88 -0.01, p=0.045).
Conclusion: The negative impact of liver cirrhosis on knee
extension strength is worsened by the severity of the disease.
Transplantation leads to impaired knee extension strength.
Conversely, exercise training tends to be beneficial, making
rehabilitation pre and post-transplantation an attractive strategy
to prevent muscle mass and strength loss.
