3.1. Intra-Rater and Inter-Rater Reliability

For intra-observer precision, the ICC with Cronbach’s alpha of the QCT measurement was 0.955 (95% CI, 0.841–0.988) with 0.953 for L1, 0.942 (95% CI, 0.797–0.984) with 0.942 for L2, 0.972 (95% CI, 0.901–0.992) with 0.969 for L3, and 0.940 (95% CI, 0.787–0.984) with 0.934 for L4. Meanwhile, the ICC with the Cronbach’s alpha of QCT measurement for inter-observer precision was 0.943 (95% CI, 0.80–0.985) with 0.948 for L1, 0.946 (95% CI, 0.810–0.985) with 0.943 for L2, 0.975 (95% CI, 0.913–0.993) with 0.974 for L3, and 0.975 (95% CI, 0.913–0.993) with 0.976 for L4. The ICC’s values indicated an excellent level of agreement, and the Cronbach’s alphas demonstrated excellent internal consistency of the QCT measurements.

3.2. Patient CharacteristicsBaseline data in all patients are presented in Table 1. During the study period, CT was performed for 70 patients (65 males in the majority, 92.9%, and 5 females, 7.1%). The age ranged from 53 to 66.5 years, and the patients with viral cirrhosis were significantly older than patients with alcohol cirrhosis (p-value = 0.020). There were 55 cases (78.6%) of history of hepatic decompensation, with more cases for patients with alcoholic cirrhosis (p-value = 0.015). Twenty-four cases (34.3%) had jaundice, with more cases for patients with alcoholic cirrhosis (p-value = 0.008). Of the 70 patients, 33 (47.1%) had cirrhosis complicated by ascites (no differences between the two groups, p-value = 0.247), 59 (84.3%) had varices (no differences between the two groups, p-value = 0.096), and 14 (20%) had hepatic encephalopathy (no differences between the two groups, p-value = 0.087). There were 25 (35.7%) patients in Child–Pugh A, 26 (37.1%) patients in Child–Pugh B, and 19 (27.1%) patients in Child–Pugh C (with more viral cirrhosis patients in Child–Pugh A and more alcohol cirrhosis patients in Child–Pugh B or C). The CONUT score has values between 0 to 11 (with median 5), according to which a normal nutritional state was found in 14 (20%) patients, a mild nutritional state in 18 (25.7%), a moderate nutritional state in 25 (35.7%), and a severe malnutrition state in 13 (18.6%) (no notable differences were found between the two groups, p-value = 0.158). Only 30 (43%) were obese or overweight.Among the LC patients, 15 had osteoporosis and 49 had osteopenia at the lumbar spine (L1–L4 vertebrae), as determined by BMD via QCT. Regarding osteoporosis, no differences were found between viral and alcohol type of LC patients (p-value = 0.870), as shown in Table 2.

No differences were obtained for calcium levels between patients with and without osteoporosis (p-value = 0.493). Significantly higher values were obtained for QCT score (100.17 ± 16.16 vs. 70.42 ± 9.39, p-value < 0.001) and T-score (−1.61 ± 0.57 vs. −1.94 ± 0.73, p-value = 0.035) for patients without osteoporosis, comparative to the patients with osteoporosis.

Comparing the 25 patients in Child–Pugh A, 26 patients in Child–Pugh B, and 19 patients in Child–Pugh C, the CONUT score was significantly different, as in Figure 2: Child–Pugh A vs. B, p-value p-value p-value The BMD derived from CT was not significantly different among the Child–Pugh classifications (Child–Pugh A vs. B p-values = 0.486; Child–Pugh A vs. C p-values = 0.515; Child–Pugh B vs. C p-values = 0.973), as in Figure 3. The BMD score ranged from 42.07 to 153.79 in patients with Child–Pugh A (mean ± SD, 96.26 ± 23.1; median (IQR), 93.83 (81.2–113.49)), 65.99 to 152.56 in patients with Child–Pugh B (mean ± SD, 92.81 ± 17.89; median (IQR), 90.87 (82.77–101.93)), and 59.88 to 124.2 in patients with Child–Pugh C (mean ± SD, 91.89 ± 16.18; median (IQR), 95.72 (77.82–102.15)).Significant positive correlation with CONUT score was found with the Model for End-Stage Liver Disease index (MELD) (rho = 0.576, p-value p-value p-value = 0.001), AST (rho = 0.293, p-value = 0.045), and bilirubin (rho = 0.395, p-value = 0.02), as shown in Figure 4. We obtained a positive significant correlation between the T-score (BMD DEXA) and lumbar QCT (Spearman’s rho = 0.361, p-value = 0.002).

The patients with jaundice had a CONUT score much higher than the patients without jaundice (p-value < 0.0001). The same significantly higher values were obtained in the case of the patients with encephalopathy (p-value < 0.0001), ascites (p-value < 0.0001), or history of hepatic decompensation (p-value < 0.0001).

Significant negative correlation with CONUT score was found with TP (rho = −0.284, p-value = 0.017) and hemoglobin (rho = −0.645, p-value < 0.0001).

CONUT score did not correlate with BMD determined by CT (rho = 0.078, p-value = 0.520).

The BMD determined by QCT was negatively correlated with age (rho = −0.645, p-value < 0.0001) and positively correlated with the varices grade (rho = 0.260, p-value = 0.030). Osteoporosis (small values of BMD) was found more significantly in patients with obesity (p-value = 0.048).

Seven potential risk factors were found to be associated with osteoporosis through univariate analysis: age, obesity, varices, grade of varices, Child–Pugh score, MELD score, and alanine aminotransferase (ALT). As in Table 3, multivariate analysis identified five significant factors associated with osteoporosis in patients with LC: age, obesity, grade of varices, Child–Pugh score, and MELD score.