Department of Medicine, Center for Liver Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Division of Otolaryngology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Gastroenterol. 2020 Jun;115(6):859-866. doi: 10.14309/ajg.0000000000000609.
Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events.
For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients.
Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy.
Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.
衰弱和肌肉减少症是肝移植不良结局和死亡的已知危险因素。我们假设衰弱或肌肉减少症可以识别常见严重移植相关呼吸不良事件的风险。
对 107 例（74 名男性，33 名女性）在 1 年内接受肝移植的患者，我们使用步态速度、椅子站立和 Karnofsky 表现量表（KPS）测量衰弱程度，使用 L3 处的计算机断层扫描测量骨骼肌指数来测量肌肉减少症。我们记录了应激测试的心脏双乘积，作为心脏工作量的指标。结果包括插管天数、吸入、临床肺炎、再插管/气管切开术、出院天数和生存率。我们使用未调整的回归模型和多变量分析来模拟结果，这些分析控制了（i）年龄、性别和终末期肝病模型钠（MELDNa）或儿童-图尔科特-佩格评分中的一种，（ii）肝细胞癌状态，和（iii）慢性阻塞性肺疾病和吸烟史。对活体供肝移植和已故供肝移植受者进行了亚组分析。
在未调整和 MELDNa 调整的模型中，步态速度与吸入和肺部感染均呈负相关（吸入的调整优势比为 0.10 [95%置信区间 [CI] 0.02-0.67]，肺部感染的调整优势比为 0.12 [95% CI 0.02-0.75]）。步态速度（系数-1.47，95%CI-2.39 至-0.56）和 KPS（系数-3.17，95%CI-5.02 至-1.32）的未调整和 MELDNa 调整模型与较短的插管时间显著相关。没有测试与住院时间或再插管或气管切开术的需求相关。
缓慢的步态速度，是一般虚弱的指标，表明移植后呼吸并发症的风险显著增加。干预以阻止或逆转虚弱状态值得探索，作为改善移植呼吸结果的潜在可改变风险因素。
