肌少脂性肥胖与接受肝移植评估患者的虚弱及身体功能差相关：一项队列研究。

Myosteatosis Is Associated With Frailty and Poor Physical Function in Patients Undergoing Liver Transplant Evaluation: A Cohort Study.

作者信息

Johnston Heidi E, Andelkovic Melita, Mayr Hannah L, Chen Yanyan, Thrift Aaron P, Macdonald Graeme A, Hickman Ingrid J

机构信息

Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.

Queensland Liver Transplant Service, Facility is Princess Alexandra Hospital, Brisbane, QLD, Australia.

出版信息

Clin Transplant. 2024 Dec;38(12):e70034. doi: 10.1111/ctr.70034.

DOI:10.1111/ctr.70034

PMID:39624939

Abstract

INTRODUCTION

Myosteatosis is fat infiltration within skeletal muscle. The impact of myosteatosis on physical function and clinical outcomes in patients referred for liver transplantation (LT) is unclear. We explored associations between myosteatosis and sarcopenia, frailty, physical function, and pre- and early post-LT outcomes.

METHODS

Myosteatosis was assessed by computed tomography (CT) in 237 patients referred for LT (March 2018 to September 2022). Chi-square/Fishers exact tests and multivariable regression compared myosteatosis and sarcopenia, frailty (liver frailty index), physical function (short physical performance battery, SPPB); and associations with pre-LT unplanned hospitalizations, post-LT surgical complications (Clavien-Dindo grade ≥ 3), and LT admission length of stay (LOS). Kaplan-Meier and Cox-proportional hazards models explored myosteatosis and time to LT and unplanned admission. Fine-Gray model evaluated the competing risks of receiving an LT.

RESULTS

Myosteatosis was present in 74 (31%) patients. Patients with myosteatosis were 2.5 times (95% confidence interval [CI] 1.1-5.7, p = 0.03) more likely to be frail, and 3.0 times (95% CI 1.6-5.6, p < 0.001) more likely to have a poor physical function (SPPB ≤ 9/12) than those without myosteatosis. Patients with myosteatosis versus those without were more likely to have a pre-LT unplanned hospitalization (51% vs. 36%, p = 0.03), but significance was lost after adjusting for age, sex, Model for End-stage Liver Disease (MELD), and the presence of hepatocellular carcinoma. Myosteatosis did not impact the likelihood of receiving an LT (p = 0.39), post-LT complications (p = 0.93), or LOS in intensive care unit (ICU) (p = 0.66) or hospital (p = 0.34).

CONCLUSIONS

Myosteatosis is prevalent in patients referred for LT and is associated with impaired physical function. Using existing CTs to assess myosteatosis in practice may help identify physically compromised patients.

摘要

引言

肌脂肪变性是指骨骼肌内的脂肪浸润。肌脂肪变性对接受肝移植（LT）患者的身体功能和临床结局的影响尚不清楚。我们探讨了肌脂肪变性与肌肉减少症、虚弱、身体功能以及肝移植术前和术后早期结局之间的关联。

方法

对237例接受肝移植的患者（2018年3月至2022年9月）进行计算机断层扫描（CT）评估肌脂肪变性。采用卡方检验/费舍尔精确检验和多变量回归比较肌脂肪变性与肌肉减少症、虚弱（肝脏虚弱指数）、身体功能（简短身体性能量表，SPPB）；以及与肝移植术前计划外住院、肝移植术后手术并发症（Clavien-Dindo分级≥3级）和肝移植住院时间（LOS）的关联。Kaplan-Meier和Cox比例风险模型探讨了肌脂肪变性与肝移植时间和计划外入院时间的关系。Fine-Gray模型评估了接受肝移植的竞争风险。

结果

74例（31%）患者存在肌脂肪变性。与无肌脂肪变性的患者相比，有肌脂肪变性的患者虚弱的可能性高2.5倍（95%置信区间[CI]1.1-5.7，p=0.03），身体功能差（SPPB≤9/12）的可能性高3.0倍（95%CI 1.6-5.6，p<0.001）。有肌脂肪变性的患者与无肌脂肪变性的患者相比，更有可能在肝移植术前出现计划外住院（51%对36%，p=0.03），但在调整年龄、性别、终末期肝病模型（MELD）和肝细胞癌的存在后，这种差异不再显著。肌脂肪变性不影响接受肝移植的可能性（p=0.39）、肝移植术后并发症（p=0.93）或重症监护病房（ICU）住院时间（p=0.66）或医院住院时间（p=0.34）。