Department of Gastroenterology, KIMS Hospital, P.O. Box: Anayara PO, Trivandrum, 695 029, India.
Indian J Gastroenterol. 2022 Oct;41(5):440-445. doi: 10.1007/s12664-022-01262-3. Epub 2022 Nov 7.
Modalities available for severity assessment and prediction of complications after liver transplant (LT) in cirrhotic patients are model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. The limitation of these scores is the lack of assessment of nutritional and functional status. Sarcopenia is a newer modality, which is developed for objective assessment of nutritional status. The aim of this study is to analyze the significance of sarcopenia in predicting 1-year mortality and morbidity in post-LT patients.
In this retrospective study, patients who underwent LT for cirrhosis between January 2013 and December 2018 were included. A computerized tomography (CT) image was used to analyze the psoas muscle index at the L3 vertebra (L3-PMI), and sarcopenia was defined as the values belonging to the lowest quartile of L3-PMI. The effect of sarcopenia on mortality and morbidity in terms of requirement for mechanical ventilation, duration of hospital stay, and occurrence of infections was studied.
Among the study population (n = 74), 71 were men and the mean age was 51 years. Sarcopenia was observed in 27% (n = 20). Fifteen recipients had mortality within 1 year after transplant. In our analysis, sarcopenia was significantly associated with 1-year mortality (sensitivity 60%, specificity 81%; positive predictive value [PPV] 45%; negative predictive value [NPV] 88%; and p-value 0.001). Duration of mechanical ventilation, total hospital stay, and occurrence of infection were not significantly associated with sarcopenia. Sarcopenia was found as an independent predictor of mortality on binary logistic regression.
The preoperative sarcopenia index in cirrhotic patients can predict the risk of mortality in post-liver transplant patients.
用于评估肝硬化患者肝移植（LT）后严重程度和并发症预测的方法包括终末期肝病模型钠（MELD-Na）和Child-Turcotte-Pugh（CTP）评分。这些评分的局限性在于缺乏对营养和功能状态的评估。肌少症是一种较新的方法，用于客观评估营养状况。本研究旨在分析肌少症预测 LT 后患者 1 年死亡率和发病率的意义。
在这项回顾性研究中，纳入了 2013 年 1 月至 2018 年 12 月期间因肝硬化接受 LT 的患者。使用计算机断层扫描（CT）图像分析第 3 腰椎（L3）椎体的竖脊肌指数（L3-PMI），将肌少症定义为 L3-PMI 值属于最低四分位数的情况。研究了肌少症对死亡率和发病率的影响，包括需要机械通气、住院时间和感染的发生。
在研究人群（n=74）中，71 名男性，平均年龄为 51 岁。27%（n=20）的患者存在肌少症。15 名受者在移植后 1 年内死亡。在我们的分析中，肌少症与 1 年死亡率显著相关（敏感性 60%，特异性 81%；阳性预测值 [PPV] 45%；阴性预测值 [NPV] 88%；p 值 0.001）。机械通气时间、总住院时间和感染的发生与肌少症无显著相关性。肌少症被发现是二元逻辑回归中死亡率的独立预测因子。
肝硬化患者术前肌少症指数可预测肝移植后患者的死亡风险。
