Liver Unit, Cardarelli Hospital, Napoli, Italy. .
Liver Unit, Cardarelli Hospital, Napoli, Italy.
J Gastrointestin Liver Dis. 2021 Mar 12;30(1):94-102. doi: 10.15403/jgld-3071.
Patients with liver cirrhosis (LC) often have malnutrition (MN), which can be associated with decompensation, infection, and death. The aims were to determine: the prevalence of MN in patients with LC and ascites, its impact on mortality, and the relationship between MN and spontaneous bacterial peritonitis (SBP).
Nutritional status (NS) was analysed in cirrhotic patients, experiencing their first episode of ascites, who were consecutively admitted at two clinical liver centres between November 2014 and October 2016. The participants underwent diagnostic paracentesis and were followed up to assess their outcomes.
110 participants underwent NS assessment in addition to routine clinical procedures. The prevalence of MN was 30.9% according to corrected body mass index, 67.3% according to upper mid-arm muscle area (UMA) and 40% according to upper mid-arm fat area (UFA). The percentages of the participants remaining alive were 68.1% at 3 months, 59.3% at 6 months, 45.1% at 12 months and 24.2% at the end of the study. Univariate analysis showed that SBP, model for end-stage liver disease (MELD), UFA, UMA and age were significantly associated with mortality. Multivariate analysis showed that only SBP, MELD and UFA (hazard ratio 2.2) were independently associated with mortality. There was a correlation between adipopenia, but not sarcopenia, and SBP.
Adipopenia, as assessed by UFA, was present in 40% of the cirrhotic patients, and it was independently associated with mortality.
肝硬化（LC）患者常伴有营养不良（MN），这可能与失代偿、感染和死亡有关。本研究旨在确定：LC 伴腹水患者 MN 的患病率、对死亡率的影响，以及 MN 与自发性细菌性腹膜炎（SBP）的关系。
2014 年 11 月至 2016 年 10 月，连续在两家临床肝脏中心收治首次发生腹水的肝硬化患者，对其进行营养状况（NS）分析，并进行诊断性腹腔穿刺术，随访评估结局。
110 名参与者除了常规临床检查外，还进行了 NS 评估。根据校正体重指数（BMI），MN 的患病率为 30.9%；根据上臂中部肌肉面积（UMA）为 67.3%；根据上臂中部脂肪面积（UFA）为 40%。3 个月时，68.1%的参与者存活；6 个月时，59.3%的参与者存活；12 个月时，45.1%的参与者存活；研究结束时，24.2%的参与者存活。单因素分析显示，SBP、终末期肝病模型（MELD）评分、UFA、UMA 和年龄与死亡率显著相关。多因素分析显示，只有 SBP、MELD 和 UFA（风险比 2.2）与死亡率独立相关。脂肪减少与 SBP 相关，但肌肉减少与 SBP 无关。
UFA 评估的脂肪减少在 40%的肝硬化患者中存在，且与死亡率独立相关。
