Department of Hepatology, Gastroenterology, and Transplantation (HEGITO), 2 Department of Medicine, Slovak Medical University, FD Roosevelt Faculty Hospital, Nám. L. Svobodu 1, Banska Bystrica 97517, Slovakia.
Gastroenterology and Hepatology Subdivision, 5 Department of Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava, Ruzinovska 6, Bratislava 82606, Slovakia.
Can J Gastroenterol Hepatol. 2021 May 21;2021:5576531. doi: 10.1155/2021/5576531. eCollection 2021.
Physical frailty increases susceptibility to stressors and predicts adverse outcomes of cirrhosis. Data on disease course in different etiologies are scarce, so we aimed to compare the prevalence and risk factors of frailty and its impact on prognosis in nonalcoholic fatty liver (NAFLD) and alcoholic (ALD) cirrhosis. . Cirrhosis registry RH7 operates since 2014 and includes hospitalized patients with decompensated cirrhosis, pre-LT evaluation, or curable hepatocellular carcinoma (HCC). From the RH7, we identified 280 ALD and 105 NAFLD patients with at least 6 months of follow-up.
Patients with NAFLD compared with ALD were older and had a higher proportion of females, higher body mass index (BMI) and mid-arm circumference (MAC), lower MELD score, CRP, and lower proportion of refractory ascites. The liver frailty index did not differ, and the prevalence of HCC was higher (17.1 vs. 6.8%, =0.002). Age, sex, serum albumin, and C-reactive protein (CRP) were independent predictors of frailty. In NAFLD, frailty was also associated with BMI and MAC and in ALD, with the MELD score. The Cox model adjusted for age, sex, MELD, CRP, HCC, and LFI showed that NAFLD patients had higher all-cause mortality (HR = 1.88 95% CI 1.32-2.67, < 0.001) and were more sensitive to the increase in LFI (HR = 1.51, 95% CI 1.05-2.2).
Patients with NAFLD cirrhosis had a comparable prevalence of frailty compared to ALD. Although prognostic indices showed less advanced disease, NAFLD patients were more sensitive to frailty, which reflected their higher overall disease burden and led to higher all-cause mortality.
身体虚弱会增加对压力源的易感性，并预测肝硬化的不良后果。关于不同病因的疾病过程的数据很少，因此我们旨在比较非酒精性脂肪性肝病 (NAFLD) 和酒精性 (ALD) 肝硬化中虚弱的患病率和危险因素及其对预后的影响。RH7 肝硬化登记处自 2014 年起运作，包括失代偿性肝硬化、LT 前评估或可治愈的肝细胞癌 (HCC) 的住院患者。我们从 RH7 中确定了 280 名 ALD 和 105 名 NAFLD 患者，他们的随访时间至少为 6 个月。
与 ALD 患者相比，NAFLD 患者年龄较大，女性比例较高，体重指数 (BMI) 和上臂中部周长 (MAC) 较高，MELD 评分、C 反应蛋白 (CRP) 较低，难治性腹水的比例较低。肝脏虚弱指数没有差异，肝癌的患病率较高（17.1%比 6.8%，=0.002）。年龄、性别、血清白蛋白和 C 反应蛋白 (CRP) 是虚弱的独立预测因素。在 NAFLD 中，虚弱也与 BMI 和 MAC 相关，而在 ALD 中，与 MELD 评分相关。调整年龄、性别、MELD、CRP、HCC 和 LFI 的 Cox 模型显示，NAFLD 患者的全因死亡率更高（HR=1.88，95%CI 1.32-2.67，<0.001），对 LFI 的增加更敏感（HR=1.51，95%CI 1.05-2.2）。
与 ALD 相比，NAFLD 肝硬化患者虚弱的患病率相当。尽管预后指数显示疾病进展程度较低，但 NAFLD 患者对虚弱更为敏感，这反映了他们更高的整体疾病负担，并导致全因死亡率更高。
