Nishikawa Hiroki, Enomoto Hirayuki, Iwata Yoshinori, Kishino Kyohei, Shimono Yoshihiro, Hasegawa Kunihiro, Nakano Chikage, Takata Ryo, Ishii Akio, Nishimura Takashi, Yoh Kazunori, Aizawa Nobuhiro, Sakai Yoshiyuki, Ikeda Naoto, Takashima Tomoyuki, Iijima Hiroko, Nishiguchi Shuhei
Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Medicine (Baltimore). 2017 Jan;96(3):e5800. doi: 10.1097/MD.0000000000005800.
The aim of this study was to examine the effect of nonprotein respiratory quotient (npRQ), as assessed using indirect calorimetry, on clinical outcomes in patients with liver cirrhosis (LC). A total of 244 LC patients were evaluated in this study. For the univariate analysis, for each continuous variable, the optimal cutoff value that maximized the sum of sensitivity and specificity was selected using receiver operating curve (ROC) analysis for survival. There were 137 men and 107 women with the median (range) age of 67 (25-90) years. Indirect calorimetry indicated that 54 patients (22.1%) had hepatocellular carcinoma (HCC) on radiological findings and 59 patients (24.2%) had protein energy malnutrition, as defined by npRQ <0.85 and serum albumin level <3.5 g/dL. In ROC analysis of npRQ for survival, the optimal cutoff point of npRQ was 0.849 for all cases (area under the ROC = 0.61272; sensitivity, 66.22%; and specificity, 57.06%). The median follow-up periods after indirect calorimetry were 4.35 years (range, 1.01-9.66 years) in patients with npRQ ≥0.85 (n = 122) and 3.71 years (range, 0.19-9.51 years) in patients with npRQ <0.85 (n = 122). The 1-, 3-, and 5-year cumulative OS rates in patients with npRQ ≥0.85 were 100%, 87.79%, and 77.24%, respectively, whereas those in patients with npRQ <0.85 were 94.26%, 73.65% and 57.78%, respectively (P = 0.0004). In the multivariate analysis, presence of HCC (P = 0.0045), body mass index (P < 0.0001), serum albumin (P = 0.0441), prothrombin time (P = 0.0463), npRQ (P = 0.0024), estimated glomerular filtration rate (P = 0.0086), and des-γ-carboxy prothrombin (P = 0.0268) were found to be significant predictors associated with OS. For all cases, risk stratification for survival was well performed using these significant variables. In conclusion, npRQ value, as assessed by indirect calorimetry, can be helpful for predicting clinical outcomes for LC patients.
本研究的目的是探讨使用间接测热法评估的非蛋白呼吸商（npRQ）对肝硬化（LC）患者临床结局的影响。本研究共评估了244例LC患者。在单因素分析中，对于每个连续变量，使用生存的受试者工作特征曲线（ROC）分析选择使敏感性和特异性之和最大化的最佳截断值。共有137名男性和107名女性，年龄中位数（范围）为67（25 - 90）岁。间接测热法显示，54例患者（22.1%）经影像学检查发现患有肝细胞癌（HCC），59例患者（24.2%）存在蛋白质能量营养不良，定义为npRQ < 0.85且血清白蛋白水平 < 3.5 g/dL。在npRQ对生存的ROC分析中，所有病例的npRQ最佳截断点为0.849（ROC曲线下面积 = 0.61272；敏感性为66.22%；特异性为57.06%）。npRQ≥0.85的患者（n = 122）间接测热法后的中位随访期为4.35年（范围1.01 - 9.66年），npRQ < 0.85的患者（n = 122）为3.71年（范围0.19 - 9.51年）。npRQ≥0.85的患者1年、3年和5年累积总生存率分别为100%、87.79%和77.24%，而npRQ < 0.85的患者分别为94.26%、73.65%和57.78%（P = 0.0004）。在多因素分析中，发现HCC的存在（P = 0.0045）、体重指数（P < 0.0001）、血清白蛋白（P = 0.0441）、凝血酶原时间（P = 时0.0463）、npRQ（P = 0.0024）、估计肾小球滤过率（P = 0.0086）和去γ - 羧基凝血酶原（P = 0.0268）是与总生存相关的显著预测因素。对于所有病例，使用这些显著变量对生存进行风险分层效果良好。总之，通过间接测热法评估的npRQ值有助于预测LC患者的临床结局。
