Phase Angle/C-reactive Protein-Index as a Novel Combined Tool for Predicting Liver-Related Hospitalizations in MASLD-Decompensated Cirrhosis

Background: Phase angle (PA), a bioelectrical impedance analysis (BIA)-assessable marker of sarcopenia, can accurately predict hospitalizations in advanced chronic liver disease (ACLD). PA has never been specifically investigated in metabolic dysfunction-associated steatotic liver disease (MASLD). Sarcopenia is commonly observed in patients with MASLD, whereas individuals with compensated ACLD (cACLD)-MASLD progress more rapidly to decompensated ACLD (dACLD). Aims: To evaluate the PA values across the different stages of liver disease progression in MASLD, and to estimate the accuracy of the novel PA/C-reactive-protein (CRP) index (PAC-I) in predicting 3 month further liver-related events (LREs) and hospitalizations in MASLD-dACLD. Methods: Patients with MASLD were consecutively enrolled and stratified according to liver stiffness measurement (LSM) and eventual previous LREs in ≤F3 fibrosis (AF), cACLD, and dACLD. At baseline, anthropobiochemical, nutritional, and clinical data were collected. Patients with MASLD-dACLD were followed up, and further LRE-determining hospitalizations within the subsequent three months were recorded. Results: In patients with MASLD, PA values were inversely correlated with LSM, and progressively decreased according to the worsening of liver disease (cACLD vs. dACLD, p <0.0001). In patients with dACLD, PA inversely correlated with CRP levels. PAC-I showed greater accuracy and superiority compared to PA alone in predicting the occurrence of further LREs within three months (PAC-I <2.35: optimal cut-off). Consistently, patients with dACLD with PAC-I <2.35 presented a higher risk of further LREs. Conclusions: In MASLD, PA correlates with disease progression status. PAC-I represents a useful noninvasive tool in predicting short-term liver-related hospitalizations in dACLD.