Department of Health Management, Tianjin Hospital, Tianjin, China.
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.
Ann Nutr Metab. 2023;79(5):423-433. doi: 10.1159/000534152. Epub 2023 Sep 19.
The synergistic impact of coexistent malnutrition and sarcopenia on morality in hospitalized patients with decompensated cirrhosis remains elusive. This prospective cohort study aimed to delineate the prevalence concerning coexistence of malnutrition and sarcopenia and the prognosticating role on long-term mortality among cirrhosis.
Adult cirrhotic patients with decompensated episodes between 2019 and 2021 were consecutively enrolled. Malnutrition and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, respectively. The entire cohort was divided into three groups: non-malnutrition and non-sarcopenia (NN), malnutrition or sarcopenia, and coexistent malnutrition and sarcopenia (MS). Log-rank test and multivariate Cox regression model were utilized to evaluate survival status and independent risk factors for mortality, respectively.
Our findings indicated that malnutrition manifested in 44.6% of inpatients with decompensated cirrhosis, while sarcopenia presented in 16.4% of the entire cohort, indicative of a prevalence of 14.7% regarding coexistent malnutrition and sarcopenia. The Kaplan-Meier graphic demonstrated a significant difference regarding survival curves among the three groups, referring to the MS group presented with the lowest survival rate (log-rank test: p < 0.001). Moreover, coexistent malnutrition and sarcopenia were associated with nearly 4 times higher mortality risk (model 1: hazard ratio [HR] = 3.31, 95% confidence interval [CI]: 1.20-9.13, p = 0.020; model 2: HR = 4.34, 95% CI: 1.52-12.4, p = 0.006) in comparison with patients without any condition (NN group).
Malnutrition and sarcopenia had superimposed negative impacts on inpatients with decompensated cirrhosis. It is imperative to identify this vulnerable subset to provide prompt therapeutic intervention for better prognosis.
共存的营养不良和肌肉减少症对失代偿性肝硬化住院患者的死亡率的协同影响仍不清楚。本前瞻性队列研究旨在描述营养不良和肌肉减少症共存的患病率，并预测肝硬化患者的长期死亡率。
连续纳入 2019 年至 2021 年期间患有失代偿期肝硬化的成年患者。根据全球营养不良倡议（GLIM）标准和欧洲老年人肌肉减少症工作组（EWGSOP2）算法诊断营养不良和肌肉减少症。整个队列分为三组：非营养不良和非肌肉减少症（NN）、营养不良或肌肉减少症和共存的营养不良和肌肉减少症（MS）。对数秩检验和多变量 Cox 回归模型分别用于评估生存状况和死亡率的独立危险因素。
我们的研究结果表明，44.6%的失代偿性肝硬化住院患者存在营养不良，而整个队列中有 16.4%存在肌肉减少症，共存的营养不良和肌肉减少症的患病率为 14.7%。生存曲线的 Kaplan-Meier 图形显示三组之间存在显著差异，MS 组的生存率最低（对数秩检验：p < 0.001）。此外，共存的营养不良和肌肉减少症与近 4 倍的死亡率风险相关（模型 1：风险比[HR] = 3.31，95%置信区间[CI]：1.20-9.13，p = 0.020；模型 2：HR = 4.34，95% CI：1.52-12.4，p = 0.006），与无任何情况的患者（NN 组）相比。
营养不良和肌肉减少症对失代偿性肝硬化住院患者有叠加的负面影响。识别这一脆弱亚组对于提供及时的治疗干预以改善预后至关重要。
