Prokopidis Konstantinos, Affronti Marco, Testa Giuseppe D, Ungar Andrea, Cereda Emanuele, Smith Lee, Pegreffi Francesco, Barbagallo Mario, Veronese Nicola
Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Society of Meta-research and Biomedical Innovation, London, UK.
Panminerva Med. 2024 Mar;66(1):47-54. doi: 10.23736/S0031-0808.23.04863-2. Epub 2023 Aug 4.
Liver transplantation is an efficacious treatment option for those with liver cirrhosis. However, the prognostic role of sarcopenia in these patients is unknown. Given this background, we conducted a systematic review and meta-analysis of the impact of sarcopenia on mortality in patients listed, evaluated and undergoing liver transplantation.
Several databases were searched from the inception to December 2022 for observational studies regarding sarcopenia in liver transplant and mortality. We calculated the risk of mortality in sarcopenia vs. no sarcopenia using the most adjusted estimate available and summarizing the data as risk ratios (RRs) with their 95% confidence intervals (CIs). A random-effect model was considered for all analyses.
Among 1135 studies initially considered, 33 articles were included for a total of 12,137 patients (mean age: 55.3 years; 39.4% females). Over a median of 2.6 years and after adjusting for a median of 3 covariates, sarcopenia increased the risk of mortality approximately 2-fold (RR: 2.01; 95% CI: 1.70-2.36). After accounting for publication bias, the re-calculated RR was 1.75 (95% CI: 1.49-2.06). The quality of the studies was generally low, as determined by the Newcastle Ottawa Scale.
Sarcopenia was significantly linked with an increased risk of mortality in patients listed, evaluated, and undergoing a liver transplantation, indicating the need of interventional studies in this special population with the main aim to reverse this potential reversible condition and decrease mortality risk.
肝移植是肝硬化患者有效的治疗选择。然而，肌肉减少症在这些患者中的预后作用尚不清楚。在此背景下，我们对肌肉减少症对等待、评估和接受肝移植患者死亡率的影响进行了系统评价和荟萃分析。
从数据库建立至2022年12月，检索了多个数据库，以查找有关肝移植中肌肉减少症与死亡率的观察性研究。我们使用可得的最经调整的估计值计算肌肉减少症患者与非肌肉减少症患者的死亡风险，并将数据汇总为风险比（RR）及其95%置信区间（CI）。所有分析均采用随机效应模型。
在最初考虑的1135项研究中，纳入了33篇文章，共涉及12137例患者（平均年龄：55.3岁；女性占39.4%）。在中位随访2.6年并对中位3个协变量进行调整后，肌肉减少症使死亡风险增加约2倍（RR：2.01；95%CI：1.70 - 2.36）。在考虑发表偏倚后，重新计算的RR为1.75（95%CI：1.49 - 2.06）。根据纽卡斯尔渥太华量表判定，这些研究的质量普遍较低。
肌肉减少症与等待、评估和接受肝移植患者的死亡风险增加显著相关，这表明需要针对这一特殊人群开展干预性研究，主要目的是逆转这种潜在的可逆转状况并降低死亡风险。
