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Recent paradigm shifts focus to dynapenia as the primary determinant of adverse outcomes. This study aims to evaluate the role of dynapenia, as measured by handgrip strength (HGS) and ultrasound-derived diaphragmatic excursion, in predicting mortality in this population. This prospective study included consecutive outpatients with cirrhosis and hepatocellular carcinoma history attending a tertiary hepatology unit. Muscle mass was assessed in subgroups using bioimpedance analysis (BIA) and computed tomography (CT). Associations between sarcopenia proxies and 24-month all-cause mortality were analyzed with adjusted Cox regression models, and survival was estimated using Kaplan\u2013Meier curves. Ninety-one patients were included (age 73.4 \u00b1 8.1\u00a0years; 71 [78%] male); 20 (22%) had dynapenia. Twenty-two deaths occurred at two years (24.2%). Over 24\u00a0months, dynapenia (by HGS) and diaphragmatic excursion were associated with mortality in adjusted models (aHR 1.68, 95% CI 1.12\u20132.53, p = 0.012; aHR 0.58, 95% CI 0.34\u20130.97, p = 0.042). In subgroups, they remained the only muscle parameters associated with mortality, while muscle mass indices were not significant. Finally, Kaplan\u2013Meier estimates showed lower 24-month survival in dynapenic patients across groups (in overall population 65% vs. 79%, p = 0.05). Low muscle strength is a key prognostic parameter in patients with cirrhosis and HCC. In our small cohort, it was the only muscle-related measure significantly associated with mortality. These findings support further evaluation of muscle strength assessment as a potential tool for risk stratification in this population.<\/jats:p>","DOI":"10.1007\/s11739-026-04548-y","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:56:12Z","timestamp":1792194972000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of low muscle strength in predicting mortality in patients with liver cirrhosis and hepatocellular carcinoma"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8292-1134","authenticated-orcid":false,"given":"Paolo","family":"Gallo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Flagiello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"De Vincentis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Di Cola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Falcomat\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Motamedrad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Terracciani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliodoro","family":"Faiella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Picardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Antonelli-Incalzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo J.","family":"Montano-Loza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Vespasiani-Gentilucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"1","key":"4548_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. 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