A New Predictive Equation for Estimating Body Weight in Cirrhotic Patients With Refractory Ascites

Abstract

Objectives This study aims to develop a new prediction equation to estimate the dry weight (DW) of patients with refractory cirrhotic ascites since there is a lack of evidence to substantiate the current values used to adjust the wet weight in these patients. Methods Cross-sectional study, that included patients with decompensated cirrhosis undergoing large-volume paracentesis. Height (H) was measured and weight, immediately before and after paracentesis. For the prediction of DW, a linear regression model was performed using as predictor variables: gender, H, and pre-paracentesis weight (preW), as response variable: post-paracentesis weight (postW). Three-way interaction was used to test the joint effect of these predictors. The capacity of this model to predict the postW was evaluated by comparing it with the currently used predictions through the intraclass correlation coefficient (ICC) and the mean square error (MSE). Results Twenty patients were included, 16 were male. Moderate ascites was the most prevalent grade (n = 18). The mean (range) of ascitic fluid drained was 6.6 (0.45 – 16.0) L, and the difference of Wpre and Wpost was −6.8 (−0.7 – −15.7) kg. The prediction equation developed for estimating DW in male is: DW = −11.4 + 1.2 * Wpre + 0.125 * H −0.002 * Wpre * H, and in female: DW = −40.6 + 1.2 * Wpre + 0.331 * H −0.030 * Wpre * H. ICC values showed that all predictions measures were strongly correlated (r > 0.95). In comparison with current predictions, our model showed the highest ICC (r = 0.97) and the lowest MSE ( = 7.70), comparing with the current predictions (MSE = 18.63, when the preW is adjusted from absolute values and MSE = 12.75 when adjusted from percentage values), indicating more accurate prediction. Conclusions This new prediction equation showed high reliability as a weight adjustment tool for patients with refractory cirrhotic ascites. Further research is required to validate this prediction equation. Funding Sources Fundo de Incentivo à Pesquisa e Eventos (FIPE) from Hospital de Clínicas de Porto Alegre and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) from Ministry of Education of Brazil.

Measurement of mid‐arm circumference as a starting point for nutritional assessment of patients with decompensated cirrhosis: A prospective cohort study

“…In the present study, BMI and BMI cirrhosis found the lowest prevalence of malnutrition. These findings can be explained by the high prevalence of fluid overload in our population and the fact that there are no well‐validated means of adjusting body weight for the fluid retention that occurs in cirrhosis, making BMI an inaccurate measure 5,10,11 …”

“…These findings can be explained by the high prevalence of fluid overload in our population and the fact that there are no well-validated means of adjusting body weight for the fluid retention that occurs in cirrhosis, making BMI an inaccurate measure. 5,10,11 Anthropometric measurements that evaluate areas less prone to accumulating extravascular fluids appear to be more adequate for nutritional assessment. The present study has demonstrated that non-surviving patients had significantly lower MAC values, which indicates a decline in muscle mass and fat mass.…”

“…Anthropometric measurements are widely used in clinical practice and are quick, minimally invasive, inexpensive, and easy to perform 9 . However, anthropometric measurements that almost exclusively involve body weight, such as body mass index (BMI), have limited clinical value due to the fluid retention that occurs in cirrhosis 5,10,11 . Other anthropometric measurements, such as mid‐arm circumference (MAC), are assessed in the upper compartment of the body, an area less prone to accumulating extravascular fluids 12 .…”

“…9 However, anthropometric measurements that almost exclusively involve body weight, such as body mass index (BMI), have limited clinical value due to the fluid retention that occurs in cirrhosis. 5,10,11 Other anthropometric measurements, such as mid-arm circumference (MAC), are assessed in the upper compartment of the body, an area less prone to accumulating extravascular fluids. 12 Subjective Global Assessment (SGA) is a well-established and widely used bedside tool and, according to Tandon et al 5 and the ESPEN Guideline on Clinical Nutrition in Liver Disease, 2 it can adequately identify cirrhotic patients with malnutrition.…”