Dunn Michael A, Josbeno Deborah A, Schmotzer Amy R, Tevar Amit D, DiMartini Andrea F, Landsittel Douglas P, Delitto Anthony
Center for Liver Diseases, University of Pittsburgh, Pittsburgh, PA.
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.
Liver Transpl. 2016 Oct;22(10):1324-32. doi: 10.1002/lt.24506.
Frailty with sarcopenia in cirrhosis causes liver transplant wait-list attrition and deaths. Regular physical activity is needed to protect patients with cirrhosis from frailty. We subjectively assess physical performance in selecting patients for transplant listing, but we do not know whether clinical assessments reflect the extent of activity patients actually perform. To investigate this question, 53 wait-listed patients self-assessed their performance of ordinary physical tasks using the Rosow-Breslau survey, and clinicians assessed their physical performance status with the Karnofsky index. We compared these assessments with actual activity measured using an accelerometer/thermal sensing armband worn from 4 to 7 days. We found that their measured activity was among the lowest reported in chronic disease, similar to that of patients with advanced chronic pulmonary disease or renal failure. Their percentages of waking hours spent in sedentary, light, and moderate-vigorous activity were 75.9% ± 18.9%, 18.9% ± 14.3%, and 4.9% ± 6.9%, respectively. Higher mean sedentary and lower mean moderate-vigorous activity was significantly associated with 9 wait-list deaths (P = 0.004). Compared with a range of 7000-13,000 steps/day in healthy adults, patients' mean steps/day were 3164 ± 2842. Both their activity percentage and step data were typical of other severely inactive populations. Neither their Rosow-Breslau scores (mean 2.3 ± 0.8, maximum 3.0) nor their Karnofsky scores (mean 79 ± 12, maximum 100) suggested major impairment or showed a correlation with patients' actual physical performance. In conclusion, physical activity in patients with cirrhosis wait-listed for transplantation is highly sedentary. Self-assessments and provider assessments of physical activity do not reliably indicate actual performance. Whether the gap between assessed and actual performance may be favorably modified by interventions to improve activity and ameliorate frailty merits further study. Liver Transplantation 22 1324-1332 2016 AASLD.
肝硬化患者的衰弱伴肌少症会导致肝移植等待名单上的患者流失和死亡。需要定期进行体育活动来保护肝硬化患者免受衰弱影响。我们在选择移植名单上的患者时主观评估身体表现，但我们不知道临床评估是否反映了患者实际进行的活动程度。为了研究这个问题，53名等待移植的患者使用罗索-布雷斯劳调查对自己进行日常身体任务的表现进行了自我评估，临床医生用卡诺夫斯基指数评估了他们的身体表现状况。我们将这些评估与使用佩戴4至7天的加速度计/热感应臂带测量的实际活动进行了比较。我们发现，他们测量的活动量处于慢性病报告中最低的水平，与晚期慢性肺病或肾衰竭患者的活动量相似。他们在久坐、轻度和中度至剧烈活动中度过的清醒时间百分比分别为75.9%±18.9%、18.9%±14.3%和4.9%±6.9%。较高的平均久坐时间和较低的平均中度至剧烈活动量与等待名单上的9例死亡显著相关（P = 0.004）。与健康成年人每天7000-13000步的范围相比，患者的平均每日步数为3164±2842。他们的活动百分比和步数数据在其他严重缺乏活动的人群中很典型。他们的罗索-布雷斯劳评分（平均2.3±0.8，最高3.0）和卡诺夫斯基评分（平均79±12，最高100）均未表明有重大损伤，也未显示与患者实际身体表现有相关性。总之，等待肝移植的肝硬化患者的身体活动高度久坐。对身体活动的自我评估和医生评估并不能可靠地表明实际表现。评估表现与实际表现之间的差距是否可以通过改善活动和减轻衰弱的干预措施得到有利改善，值得进一步研究。《肝脏移植》2016年第22卷，第1324-1332页，美国肝脏病研究协会
