Gastroenterology and Liver Services, Concord Hospital, Sydney, NSW, Australia.
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Liver Int. 2018 Dec;38(12):2117-2128. doi: 10.1111/liv.13917. Epub 2018 Jul 15.
Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiological parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients. It is a complex construct consisting of multisystemic physiological decline and increased vulnerability to stressors. Diagnosis is complicated by lack of a consensus definition and measurement tool for frailty in cirrhosis. Frailty heralds a poor prognosis, predicting increased morbidity and mortality both pre- and postliver transplant, independent of MELD score. It is thought to be reversible, with promising data supporting prehabilitation and lifestyle intervention programs. In the future, assessment of patients with cirrhosis is likely to incorporate a measure of frailty, however, further research is required.
肝硬化患者的预后较为复杂，不仅取决于肝脏疾病的严重程度，还取决于其他因素。例如，终末期肝病模型（MELD）和 Child-Pugh 评分等指标有助于预测预后，但它们主要侧重于生理参数，无法全面反映导致患者临床状况的因素。有越来越多的证据表明，身体机能对于患者的预后结果具有重要影响。近年来，医学文献中越来越多地提到衰弱问题，包括在肝病学领域，近一半的肝硬化患者都存在衰弱问题。它是一种复杂的多系统生理衰退和对压力源易感性增加的综合表现。由于缺乏关于肝硬化患者衰弱的共识定义和测量工具，其诊断较为复杂。衰弱预示着预后不良，无论在肝移植前还是肝移植后，都与 MELD 评分无关，它会增加发病率和死亡率。人们认为它是可以逆转的，有一些有前途的研究数据支持衰弱前康复和生活方式干预项目。未来，对肝硬化患者的评估可能会纳入衰弱指标，但仍需要进一步研究。
