Internal Medicine Residency Program.
Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Clin Gastroenterol Hepatol. 2022 Aug;20(8):1813-1820.e2. doi: 10.1016/j.cgh.2022.03.012. Epub 2022 Mar 21.
BACKGROUND & AIMS: Daily step count measures cardiorespiratory fitness and has been associated with clinical outcomes. However, its utility in patients with cirrhosis remains largely unexplored. We aimed to investigate the association between step count, frailty metrics, and clinical outcomes in cirrhosis.
All participants underwent frailty evaluation with the liver frailty index, 6-minute walk test, and gait speed test. To monitor step count, participants were given a personal activity tracker (PAT). A subset also was invited to use Exercise and Liver FITness (EL-FIT). Daily step counts from the first week of PAT use and frailty metrics were investigated as predictors of hospital admission and mortality.
There were 116 patients included (age, 56 ± 11 y; male, 55%; body mass index, 31 ± 7; model for end-stage liver disease-sodium, 15 ± 7). The main etiologies of cirrhosis were alcohol-related (33%) and nonalcoholic steatohepatitis (30%). Monitoring for the week was accomplished in 80% of participants given both PAT+EL-FIT vs 62% in those with PAT only (P = .04). During follow-up evaluation, hospital admission was observed in 55% and death in 15%. Kaplan-Meir curves showed increased readmission and deaths among patients performing in the lowest quartile (ie, <1200 steps/d). When adjusted by model for end-stage liver disease-sodium and EL-FIT use, the lowest quartile was associated with hospital admission and death (hazard ratio, HR [95% confidence interval], 1.90 [1.09-3.30] and 3.46 [1.23-9.68], respectively), along with the 6-minute walk test (HR, 0.63 [0.47-0.83] and 0.66 [0.44-0.99] per 100 m, respectively) and gait speed test (HR, 0.29 [0.11-0.72] and 0.21 [0.05-0.84], respectively).
Daily step count predicted hospital admission and mortality rates in patients with cirrhosis, similar to the current standard frailty metrics. Incorporation of a physical training-dedicated smartphone application was associated with increased PAT use and step reporting.
日常步数可衡量心肺适能，且与临床结局相关。然而，其在肝硬化患者中的应用仍有待充分研究。本研究旨在探讨肝硬化患者的步数、衰弱指标与临床结局之间的关系。
所有参与者均接受了肝脏衰弱指数、6 分钟步行试验和步态速度测试的衰弱评估。为了监测步数，参与者被给予个人活动追踪器（PAT）。一部分参与者还被邀请使用 Exercise and Liver FITness（EL-FIT）。研究了 PAT 使用第一周的每日步数和衰弱指标作为住院和死亡的预测因子。
共纳入 116 例患者（年龄 56±11 岁；男性占 55%；体重指数 31±7；终末期肝病模型钠校正值 15±7）。肝硬化的主要病因是酒精相关性（33%）和非酒精性脂肪性肝炎（30%）。接受 PAT+EL-FIT 的参与者中有 80%完成了一周监测，而仅接受 PAT 的参与者中只有 62%（P=0.04）。在随访评估期间，55%的患者住院，15%的患者死亡。Kaplan-Meier 曲线显示，在步数最低四分位（即<1200 步/天）的患者中，再入院和死亡的比例增加。在校正终末期肝病模型钠校正值和 EL-FIT 使用后，最低四分位与住院和死亡相关（风险比 [95%置信区间]，1.90 [1.09-3.30] 和 3.46 [1.23-9.68]），6 分钟步行试验（风险比，0.63 [0.47-0.83] 和 0.66 [0.44-0.99] 每 100 m）和步态速度试验（风险比，0.29 [0.11-0.72] 和 0.21 [0.05-0.84]）。
日常步数可预测肝硬化患者的住院和死亡率，与当前的标准衰弱指标相似。使用专门用于身体训练的智能手机应用程序与 PAT 使用和步数报告的增加相关。
