Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Eur J Gastroenterol Hepatol. 2011 Nov;23(11):982-9. doi: 10.1097/MEG.0b013e32834aa4bb.
Protein energy malnutrition frequently occurs in liver cirrhosis. Hand-grip strength according to Jamar is most reliable to predict protein energy malnutrition. We aimed to determine whether protein energy malnutrition affects complication risk.
In 84 cirrhotics, baseline nutritional state was determined and subsequent complications prospectively assessed. Influence of potentially relevant factors including malnutrition (by Jamar hand-grip strength) on complication rates were evaluated with univariate analysis. Effect of malnutrition was subsequently evaluated by multivariate logistic regression with adjustment for possible confounders.
Underlying causes of cirrhosis were viral hepatitis in 31%, alcohol in 26%, and other in 43%. Baseline Child-Pugh (CP) class was A, B, or C in 58, 35, and 7%, respectively. Energy and protein intake decreased significantly with increasing CP class, with shift from proteins to carbohydrates. At baseline, according to Jamar hand-grip strength, malnutrition occurred in 67% (n=56). Malnutrition was associated with older age and higher CP class (CP class A 57%, B 79%, C 100%) but not with underlying disease or comorbidity. Complications occurred in 18 and 48% in well-nourished and malnourished patients, respectively, (P=0.007) during 13 ± 6 months follow-up. In multivariate analysis, malnutrition was an independent predictor of complications, after correcting for comorbidity, age, and CP score (adjusted odds ratio 4.230; 95% confidence interval 1.090-16.422; P=0.037). In univariate analysis, mortality (4 vs. 18%; P=0.1) tended to be worse in malnourished patients, but this trend was lost in multivariate analysis.
Malnutrition is an independent predictor of complications in cirrhosis.
肝硬变常发生蛋白质能量营养不良。根据 Jamar 的握力是预测蛋白质能量营养不良最可靠的方法。我们旨在确定蛋白质能量营养不良是否影响并发症的风险。
在 84 例肝硬化患者中，确定了基线营养状况，并前瞻性评估了随后的并发症。用单变量分析评估了包括营养不良（根据 Jamar 握力）在内的潜在相关因素对并发症发生率的影响。随后用多元逻辑回归分析，在调整可能的混杂因素后，评估营养不良的影响。
肝硬化的基础病因分别为病毒性肝炎 31%、酒精性 26%和其他 43%。基线 Child-Pugh（CP）分级分别为 A、B 和 C 级 58%、35%和 7%。能量和蛋白质摄入随着 CP 分级的增加而显著减少，从蛋白质转移到碳水化合物。根据 Jamar 握力，基线时发生营养不良 67%（n=56）。营养不良与年龄较大和 CP 分级较高相关（CP 分级 A 为 57%，B 为 79%，C 为 100%），但与基础疾病或合并症无关。在 13±6 个月的随访期间，营养良好和营养不良的患者分别发生并发症 18%和 48%（P=0.007）。在调整合并症、年龄和 CP 评分后，营养不良是并发症的独立预测因子（调整优势比 4.230；95%置信区间 1.090-16.422；P=0.037）。在单变量分析中，营养不良患者的死亡率（4%与 18%；P=0.1）似乎更差，但在多变量分析中，这种趋势消失了。
营养不良是肝硬化并发症的独立预测因子。
