Characteristics of the included cohort studies.

Objectives
This study aimed to examine the potential correlation between myosteatosis and the prognosis of patients diagnosed with liver cirrhosis by a meta-analysis.
Methods
Cohort studies of relevance were acquired through comprehensive searches of the Medline, Web of Science, and Embase databases. To account for heterogeneity, a random-effects model was employed to combine the findings.
Results
The meta-analysis included 10 retrospective and four prospective cohort studies, encompassing a total of 4287 patients diagnosed with cirrhosis. The pooled findings indicated a notable decline in transplant-free survival (TFS) among individuals with liver cirrhosis and myosteatosis compared to those without this condition (risk ratio: 1.94; 95% confidence interval: 1.61 to 2.34, p < 0.001; I2 = 49%). The predefined subgroup analyses demonstrated consistent findings across various categories, including Asian and non-Asian studies, prospective and retrospective cohort studies, patients with cirrhosis overall and those who underwent transjugular intrahepatic portosystemic shunt, studies with different follow-up durations (< or ≥ 24 months), studies employing univariate and multivariate analyses, and studies with and without an adjustment for sarcopenia (p > 0.05 for all subgroup differences). Additionally, Egger’s regression test indicated the presence of significant publication bias (p = 0.044). However, trim-and-fill analysis by including three hypothesized studies showed consistent results.
Conclusions
The presence of myosteatosis in individuals diagnosed with liver cirrhosis may potentially be linked to a poor TFS prognosis. Further investigations are required to ascertain whether enhancing myosteatosis could potentially yield a survival advantage for this particular patient population.