Gastroenterology and Hepatology Unit, Department of Clinical Medicine, La Sapienza University of Rome, Rome, Italy.
Department of Infectious Disease, La Sapienza University of Rome, Rome, Italy.
Liver Int. 2018 May;38(5):851-857. doi: 10.1111/liv.13691. Epub 2018 Feb 10.
BACKGROUND & AIMS: Severe infections and muscle wasting are both associated to poor outcome in cirrhosis. A possible synergic effect of these two entities in cirrhotic patients has not been previously investigated. We aimed at analysing if a low muscle mass may deteriorate the outcome of cirrhotic patients with sepsis.
Consecutive cirrhotic patients hospitalized for sepsis were enrolled in the study. Patients were classified for the severity of liver impairment (Child-Pugh class) and for the presence of "low muscle mass" (mid-arm muscle circumference<5th percentile). The development of complication during hospitalization and survival was analysed.
There were 74 consecutive cirrhotics with sepsis. Forty-three of these patients showed low muscle mass. In patients with and without low muscle mass, severity of liver disease and characteristics of infections were similar. Mortality tended to be higher in patients with low muscle mass (47% vs 26%, P = .06). A multivariate analysis selected low muscle mass (P < .01, HR: 3.2, IC: 1.4-4.8) and Child-Pugh C (P < .01, HR: 3.3, 95% IC: 1.5-4.9) as independent predictors of in-hospital mortality. In Child-Pugh A-B patients, mortality was higher in patients with low muscle mass compared with those without (50% vs 16%; P = .01). The mortality rate and the incidence of complications in malnourished patients classified in Child-Pugh A-B were similar to those Child-Pugh C.
Low muscle mass worsen prognosis in cirrhotic patients with severe infections. This is particularly evident in patients with Child A-B cirrhosis in whom the coexistence of low muscle mass and sepsis caused a negative impact on mortality similar to that observable in all Child C patients with sepsis.
严重感染和肌肉减少症均与肝硬化不良预后相关。这两种情况在肝硬化患者中是否存在协同作用尚未得到研究。本研究旨在分析低肌肉量是否会使合并感染的肝硬化患者的预后恶化。
连续纳入因感染入院的肝硬化患者。根据肝损伤严重程度（Child-Pugh 分级）和“低肌肉量”（上臂中部肌肉周长<第 5 百分位数）对患者进行分类。分析住院期间并发症的发生和患者的生存率。
共有 74 例连续的肝硬化合并感染患者，其中 43 例患者存在低肌肉量。低肌肉量患者和无低肌肉量患者的肝病严重程度和感染特征相似。低肌肉量患者的死亡率较高（47% vs 26%，P =.06）。多因素分析选择低肌肉量（P <.01，HR：3.2，95%CI：1.4-4.8）和 Child-Pugh C（P <.01，HR：3.3，95%CI：1.5-4.9）作为院内死亡率的独立预测因素。在 Child-Pugh A-B 患者中，低肌肉量患者的死亡率高于无低肌肉量患者（50% vs 16%；P =.01）。Child-Pugh A-B 营养不良患者的死亡率和并发症发生率与 Child-Pugh C 患者相似。
低肌肉量会使严重感染的肝硬化患者预后恶化。在 Child A-B 肝硬化患者中，低肌肉量与感染共存对死亡率的影响类似于所有 Child C 感染患者的影响，这一现象尤为明显。
