Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman, SPC 5362, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Dig Dis Sci. 2019 Dec;64(12):3652-3659. doi: 10.1007/s10620-019-05713-4. Epub 2019 Jul 10.
Frailty and sarcopenia are associated with mortality and poor outcomes among patients with cirrhosis. Frailty is multifactorial but due in part to sarcopenia and cognitive dysfunction. Data are limited regarding the correlation of bedside frailty and cognitive function measures with sarcopenia.
To evaluate the correlations between frailty measures and muscle indices from computed tomography (CT).
We prospectively enrolled 106 patients with clinically compensated cirrhosis (and no prior hepatic encephalopathy). All patients underwent CT scan and cognitive testing (via inhibitory control test, ICT), and were subject to hand grip, 30-s chair stands, mid-arm muscle area (MAMA), and a four-question algorithm based on the Sickness Impact Profile (SIP) predictive of minimal HE. We evaluated Spearman correlations between all measures as well as the sensitivity and specificity of each measure for falls.
In total, 106 (35.3%) patients (55 men) had CT scans to measure skeletal muscle area and quality. Hand grip correlated strongly with skeletal muscle area (correlation coefficient 0.64, p < 0.001) and mildly with ICT performance (0.34, p = 0.002). However, for women, the strongest correlation with hand grip was ICT performance (0.60, p < 0.001). Chair stand performance correlated best with SIP (correlation coefficient - 0.35, p < 0.001). MAMA was not correlated with CT-based muscle indices among women but was for men. Poor chair stand performance (< 10/30-s) had a sensitivity/specificity for falls of 73%/54%; low muscle radiation attenuation (density) was 40%/80% sensitive/specific.
Bedside measures of physical function, muscle bulk, and cognitive performance are correlated with CT-based muscle measures. Bedside measures of frailty may provide an advantage over sarcopenia for outcome assessment that should be confirmed prospectively.
衰弱和肌少症与肝硬化患者的死亡率和不良预后相关。衰弱是多因素的，但部分原因是肌少症和认知功能障碍。关于床边衰弱和认知功能测量与肌少症的相关性数据有限。
评估衰弱测量与计算机断层扫描（CT）肌肉指数之间的相关性。
我们前瞻性纳入 106 例临床代偿性肝硬化（且无既往肝性脑病）患者。所有患者均行 CT 扫描和认知测试（通过抑制控制测试，ICT），并进行握力、30 秒椅站、上臂中部肌肉面积（MAMA）和基于 Sickness Impact Profile（SIP）的四项问题算法评估，以预测最小型肝性脑病。我们评估了所有测量值之间的 Spearman 相关性，以及每种测量值对跌倒的敏感性和特异性。
共 106 例（35.3%）患者（55 名男性）进行了 CT 扫描以测量骨骼肌面积和质量。握力与骨骼肌面积密切相关（相关系数 0.64，p<0.001），与 ICT 表现轻度相关（0.34，p=0.002）。然而，对于女性，与握力最强相关的是 ICT 表现（0.60，p<0.001）。椅站表现与 SIP 相关性最佳（相关系数-0.35，p<0.001）。MAMA 与女性 CT 肌肉指数不相关，但与男性相关。较差的椅站表现（<10/30 秒）对跌倒的敏感性/特异性为 73%/54%；低肌肉辐射衰减（密度）的敏感性/特异性为 40%/80%。
床边身体功能、肌肉量和认知表现的测量与 CT 肌肉测量相关。床边衰弱的测量可能比肌少症更能提供预后评估的优势，这需要前瞻性地确认。
