Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Liver Transpl. 2021 Jul;27(7):1041-1053. doi: 10.1002/lt.26052.
Physiologic reserve is an important prognostic indicator. Because of its complexity, no single test can measure an individual's physiologic reserve. Frailty is the phenotypic expression of decreased reserve and portends poor prognosis. Both subjective and objective tools have been used to measure one or more components of physiologic reserve. Most of these tools appear to predict pretransplant mortality, but only some predict posttransplant survival. Incorporation of these measures of physiologic reserve in the clinical and research settings including prediction models are reviewed, and the applicability to patient-related outcomes are discussed. Commonly used tools, in patients with cirrhosis, that have been associated with clinical outcomes were reviewed. The strength of subjective tools lies in low-cost, wide availability, and quick assessments at the bedside. A disadvantage of these tools is the manipulative capacity, restricting their value in allocation processes. The strength of objective tests lies in objective measurements and the ability to measure change. The disadvantages include complexity, increased cost, and limited accessibility. Heterogeneity in the definitions and tools used has prevented further advancement or a clear role in transplant assessment. Consistent use of objective tools, including the 6-minute walk test, gait speed, Liver Frailty Index, or Short Physical Performance Battery, are recommended in clinical and research settings.
生理储备是一个重要的预后指标。由于其复杂性，没有单一的测试可以衡量个体的生理储备。衰弱是储备减少的表型表达，并预示着预后不良。已经使用了主观和客观的工具来测量生理储备的一个或多个组成部分。这些工具中的大多数似乎可以预测移植前的死亡率，但只有一些可以预测移植后的生存率。本文综述了这些生理储备测量方法在临床和研究中的应用，包括预测模型，并讨论了其在患者相关结局中的适用性。还回顾了与肝硬化患者临床结局相关的常用工具。主观工具的优势在于成本低、广泛可用性和在床边快速评估。这些工具的一个缺点是可操作性，限制了它们在分配过程中的价值。客观测试的优势在于客观测量和测量变化的能力。缺点包括复杂性、增加的成本和有限的可及性。用于定义和评估的工具的异质性阻碍了进一步的进展或在移植评估中的明确作用。建议在临床和研究环境中一致使用客观工具，包括 6 分钟步行测试、步态速度、肝脏脆弱指数或简短体能状况测试。
