Myostatin as a Prognostic Biomarker in Hepatic Cirrhosis Patients with Sarcopenia

  • Rizki Aliana Agustina Departement of Internal Medicine, Faculty of Medicine, Sriwijaya University/Moh Hoesin Hospital, Palembang, Indonesia
  • Suyata Gastroenterohepatology Division, Departement of Internal Medicine, Faculty of Medicine, Sriwijaya University/Moh Hoesin Hospital, Palembang, Indonesia
Keywords: Sarcopenia, Liver cirrhotic, Myostatin, Prognostic Biomarkers.


Cirrhosis represents the advanced stage of numerous chronic liver conditions. Sarcopenia is a frequently overlooked complication in cirrhotic patients, resulting from factors such as insufficient protein intake, malabsorption, diminished muscle growth, and increased muscle breakdown. Sarcopenia is a multifaceted, chronic condition associated with elevated risks of morbidity and mortality. In the field of hepatology, sarcopenia is typically described as a phenotypic indication of muscle mass loss, affecting approximately 30-70% of liver cirrhosis patients. Sarcopenia has been scientifically linked to an increased risk of falls, reduced quality of life, the emergence of acute decompensated liver failure, and mortality in cirrhotic patients. Myostatin, classified as a cytokine within the transforming growth factor beta (TGF-β) family, is recognized for its role in disrupting protein synthesis. It functions as a negative regulator of muscle growth, inhibiting myogenesisand is linked to the onset of sarcopenia. Extensive literature supports the prognostic importance of sarcopenia in cirrhosis, and serum myostatin levels have the potential to serve as a valuable biomarker. Elevated myostatin concentrations have been linked to the presence of sarcopenia and decreased survival rates in individuals diagnosed with liver cirrhosis.


Muir, A. J. (2015). Understanding the complexities of cirrhosis. Clinical Therapeutics, 37(8), 1822-1836.

Sudoyo, A. W., Setiyohadi, B., Alwi, I., Simadibrata, K. M., & Setiati, S. (2014). Buku Ajar Ilmu Penyakit Dalam. Jakarta: Internal Publishing.

Diédhiou, D., Sow, D., Thioye, E. M. M., Ndour, M. A., Diallo, I. M., Gadji, F. K., ... & Mbaye, M. N. (2020). Hepatic Cirrhosis: Diagnostic and Prognosis in Internal Medicine. Open Journal of Internal Medicine, 10(02), 171-180.

Moon, A. M., Singal, A. G., & Tapper, E. B. (2020). Contemporary epidemiology of chronic liver disease and cirrhosis. Clinical Gastroenterology and Hepatology, 18(12), 2650-2666.

Saeki, C., & Tsubota, A. (2021). Influencing factors and molecular pathogenesis of sarcopenia and osteosarcopenia in chronic liver disease. Life, 11(9), 899.

Dhaliwal, A., & Armstrong, M. J. (2020). Sarcopenia in cirrhosis: A practical overview. Clinical Medicine, 20(5), 489.

Tandon, P., Montano-Loza, A. J., Lai, J. C., Dasarathy, S., & Merli, M. (2021). Sarcopenia and frailty in decompensated cirrhosis. Journal of hepatology, 75, S147-S162.

Nakano, D., Kawaguchi, T., Tsutusumi, T., Yamamura, S., Shigeto, K., Hashida, R., ... & Torimura, T. (2020). Alteration of the serum myostatin level following L carnitine treatment in patients with chronic liver disease: A pilot study. International Journal of Functional Nutrition, 1(1), 1-1.

Sharma, B., & John, S. (2022). Hepatic Cirrhosis. StatPearls. Stat-Pearls Publishing LLC., Treasure Island, FL, USA.

Tan, Z., Sun, H., Xue, T., Gan, C., Liu, H., Xie, Y., ... & Ye, T. (2021). Liver fibrosis: therapeutic targets and advances in drug therapy. Frontiers in cell and developmental biology, 9, 730176.

Roehlen, N., Crouchet, E., & Baumert, T. F. (2020). Liver fibrosis: mechanistic concepts and therapeutic perspectives. Cells, 9(4), 875.

Engelmann, C., Clària, J., Szabo, G., Bosch, J., & Bernardi, M. (2021). Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. Journal of hepatology, 75, S49-S66.

Lai, J. C., Tandon, P., Bernal, W., Tapper, E. B., Ekong, U., Dasarathy, S., & Carey, E. J. (2021). Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md.), 74(3), 1611.

Son, S. W., Song, D. S., Chang, U. I., & Yang, J. M. (2021). Definition of sarcopenia in chronic liver disease. Life, 11(4), 349.

Kim, G., Kang, S. H., Kim, M. Y., & Baik, S. K. (2017). Prognostic value of sarcopenia in patients with liver cirrhosis: a systematic review and meta-analysis. PloS one, 12(10), e0186990.

Bojko, M. (2019). Causes of sarcopenia in liver cirrhosis. Clinical Liver Disease, 14(5), 167.

Bunchorntavakul, C., & Reddy, K. R. (2020). malnutrition/sarcopenia and frailty in patients with cirrhosis. Alimentary pharmacology & therapeutics, 51(1), 64-77.

Kim, Y. (2021). Emerging treatment options for sarcopenia in chronic liver disease. Life, 11(3), 250.

Kim, H. Y., & Jang, J. W. (2015). Sarcopenia in the prognosis of cirrhosis: going beyond the MELD score. World journal of gastroenterology: WJG, 21(25), 7637.

Dasarathy, S. (2017). Myostatin and beyond in cirrhosis: all roads lead to sarcopenia. Journal of cachexia, sarcopenia and muscle, 8(6), 864.

Chen, M. M., Zhao, Y. P., Zhao, Y., Deng, S. L., & Yu, K. (2021). Regulation of myostatin on the growth and development of skeletal muscle. Frontiers in Cell and Developmental Biology, 9, 785712.

Chen, S. H., Wan, Q. S., Wang, T., & Zhang, K. H. (2020). Fluid biomarkers for predicting the prognosis of liver cirrhosis. BioMed Research International, 2020.

Nishikawa, H., Enomoto, H., Ishii, A., Iwata, Y., Miyamoto, Y., Ishii, N., ... & Nishiguchi, S. (2017). Elevated serum myostatin level is associated with worse survival in patients with liver cirrhosis. Journal of cachexia, sarcopenia and muscle, 8(6), 915-925.

How to Cite
Agustina, R. A., & Suyata. (2023). Myostatin as a Prognostic Biomarker in Hepatic Cirrhosis Patients with Sarcopenia. International Journal of Science and Society, 5(5), 488-498.