Hanai Tatsunori, Shiraki Makoto, Imai Kenji, Suetsugu Atsushi, Takai Koji, Shimizu Masahito
Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
Department of Division for Regional Cancer Control, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
J Clin Med. 2020 Apr 3;9(4):1013. doi: 10.3390/jcm9041013.
The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5-4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.93). The survival benefit of LES therapy was most prominent in patients with Child-Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20-0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33-0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.
晚期夜宵（LES）对肝硬化患者的临床疗效已有充分记录，但其对生存率的影响仍不明确。这项队列研究旨在比较接受LES治疗的患者和未接受治疗的患者的总生存率。我们进行了一项回顾性队列研究，以确定LES（定义为睡前口服富含支链氨基酸（BCAA）的营养素）对2004年3月至2019年4月在日本一家三级转诊中心就诊的523例肝硬化患者生存率的影响。使用倾向评分匹配和治疗权重逆概率分析评估LES与全因死亡率之间的关联。523名参与者的中位年龄为66岁；286名（55%）患者为男性，87名（17%）接受LES治疗。在231例倾向匹配患者中，20例（26%）接受LES治疗的患者和72例（47%）未接受治疗的患者在中位随访2.0年（四分位间距，0.5 - 4.8）期间死亡。倾向评分匹配分析显示，接受LES治疗的患者的总生存率显著高于未接受治疗的患者（风险比[HR]，0.57；95%置信区间[CI]，0.34 - 0.93）。LES治疗的生存获益在Child-Pugh C级肝硬化患者中最为显著（HR，0.40；95% CI，0.20 - 0.81）。治疗权重逆概率分析也显示，LES显著改善了肝硬化患者的预后（HR，0.57；95% CI，0.33 - 0.99）。在这项对肝硬化患者的回顾性研究中，我们发现夜间补充BCAA与肝硬化患者死亡风险的显著降低相关。
