Severe muscle depletion in patients on the liver transplant wait list: Its prevalence and independent prognostic value

Liver Transplantation - Tập 18 Số 10 - Trang 1209-1216 - 2012
Puneeta Tandon1, Michael Ney2, Ivana Irwin1, Mang Ma1, Leah Gramlich2, Vincent G. Bain1, Nina Esfandiari3, Vickie E. Baracos3, Aldo J. Montaño‐Loza1, Robert P. Myers1,4
1Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada
2Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Alberta, Canada
3Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
4Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada

Tóm tắt

As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population. Liver Transpl 18:1209–1216, 2012. © 2012 AASLD.

Từ khóa


Tài liệu tham khảo

Kamath, 2001, A model to predict survival in patients with endstage liver disease., Hepatology, 33, 464470, 10.1053/jhep.2001.22172

Bambha, 2008, Predictors of early rebleeding and mortality after acute variceal haemorrhage in patients with cirrhosis., Gut, 57, 814820, 10.1136/gut.2007.137489

Gotthardt, 2009, Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation., BMC Gastroenterol, 9, 72, 10.1186/1471-230X-9-72

Huo, 2008, Selecting an optimal prognostic system for liver cirrhosis: the Model for EndStage Liver Disease and beyond., Liver Int, 28, 606613, 10.1111/j.1478-3231.2008.01727.x

Huo, 2005, Different Model for EndStage Liver Disease score block distributions may have a variable ability for outcome prediction., Transplantation, 80, 14141418, 10.1097/01.tp.0000181164.19658.7a

Heuman, 2004, Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death., Hepatology, 40, 802810, 10.1002/hep.1840400409

Merli, 1996, Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi)., Hepatology, 23, 10411046, 10.1002/hep.510230516

Mller, 1994, Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding., J Hepatol, 21, 940946

Sam, 2009, Proteincalorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension., Liver Int, 29, 13961402, 10.1111/j.1478-3231.2009.02077.x

Alberino, 2001, Nutrition and survival in patients with liver cirrhosis., Nutrition, 17, 445450, 10.1016/S0899-9007(01)00521-4

Gunsar, 2006, Nutritional status and prognosis in cirrhotic patients., Aliment Pharmacol Ther, 24, 563572, 10.1111/j.1365-2036.2006.03003.x

Pichard, 2004, Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay., Am J Clin Nutr, 79, 613618, 10.1093/ajcn/79.4.613

Cosqueric, 2006, Sarcopenia is predictive of nosocomial infection in care of the elderly., Br J Nutr, 96, 895901, 10.1017/BJN20061943

Metter, 2002, Skeletal muscle strength as a predictor of allcause mortality in healthy men., J Gerontol A Biol Sci Med Sci, 57, B359B365, 10.1093/gerona/57.10.B359

MontanoLoza, 2012, Muscle wasting is associated with mortality in patients with cirrhosis., Clin Gastroenterol Hepatol, 10, 166173

Kim, 2008, Hyponatremia and mortality among patients on the livertransplant waiting list., N Engl J Med, 359, 10181026, 10.1056/NEJMoa0801209

Myers, 2011, Validation of the 5variable Model for EndStage Liver Disease (5VMELD) for predicting mortality on the liver transplant waiting list abstract., Hepatology, 54, 663A

Riggio, 1997, Whole body and regional body composition analysis by dualenergy Xray absorptiometry in cirrhotic patients., Eur J Clin Nutr, 51, 810814, 10.1038/sj.ejcn.1600490

1994, Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis., J Hepatol, 21, 317325

Lolli, 1992, Anthropometric assessment of the nutritional status of patients with liver cirrhosis in an Italian population., Ital J Gastroenterol, 24, 429435

Wilmore, 1991, Catabolic illness. Strategies for enhancing recovery., N Engl J Med, 325, 695702

Detsky, 1987, What is subjective global assessment of nutritional status?, JPEN J Parenter Enteral Nutr, 11, 813, 10.1177/014860718701100108

Heymsfield, 1997, Human body composition: advances in models and methods., Annu Rev Nutr, 17, 527558, 10.1146/annurev.nutr.17.1.527

Mitsiopoulos, 1998, Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography., J Appl Physiol, 85, 115122, 10.1152/jappl.1998.85.1.115

Shen, 2004, Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal crosssectional image., J Appl Physiol, 97, 23332338, 10.1152/japplphysiol.00744.2004

Baumgartner, 1998, Epidemiology of sarcopenia among the elderly in New Mexico., Am J Epidemiol, 147, 755763, 10.1093/oxfordjournals.aje.a009520

Prado, 2008, Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a populationbased study., Lancet Oncol, 9, 629635, 10.1016/S1470-2045(08)70153-0

Thuluvath, 1995, How valid are our reference standards of nutrition?, Nutrition, 11, 731733

Heymsfield, 1987, Anthropometric assessment of the adult hospitalized patient., JPEN J Parenter Enteral Nutr, 11, 36S41S

Harries, 1982, Malnutrition in inflammatory bowel disease: an anthropometric study., Hum Nutr Clin Nutr, 36, 307313

Peng, 2007, Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study., Am J Clin Nutr, 85, 12571266, 10.1093/ajcn/85.5.1257

Jones, 2012, Exercise capacity and muscle strength in patients with cirrhosis., Liver Transpl, 18, 146151, 10.1002/lt.22472

Riggio, 2003, Malnutrition is not related to alterations in energy balance in patients with stable liver cirrhosis., Clin Nutr, 22, 553559, 10.1016/S0261-5614(03)00058-X

Morgan, 2006, Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis., Hepatology, 44, 823, 10.1002/hep.21358

Thông tin
Thông tin xuất bản

Liver Transplantation

Tập 18 Số 10

1209-1216

Thông tin tác giả