Combined nutritional assessment methods to predict clinical outcomes in patients on the waiting list for liver transplantation

Ribeiro, Hélio; Maurício, Sílvia Fernandes; Silva, Thales Antônio da; Generoso, Simone de Vasconcelos; Lima, Agnaldo Soares; Correia, María Isabel Toulson Davisson

doi:10.1016/j.nut.2017.09.014

Cited by 20 publications

(16 citation statements)

References 52 publications

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“…Not only are the adverse effects of decompensation on dietary intake compounded by impaired digestion and absorption, but elevated nutritional requirements arising from multi-organ failure often result in unattainable energy and protein requirements. 24,25 . Assessment of energy balance in 73 patients awaiting liver transplant found 100% of patients failed to consume adequate calories, although the energy deficit became significantly worse as severity of liver disease progressed (-749 kcal, -612 kcal and -1,210 kcal in patients with Child-Pugh Class A, B and C, respectively) (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant

et al. 2019

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Highlights • Malnutrition and poor muscle strength are highly prevalent in cirrhotics with hepatorenal syndrome. • Terlipressin infusion increased energy and protein intake in patients with hepatorenal syndrome. • Handgrip strength continued to increase with every day of terlipressin therapy • Medium to long-term terlipressin infusion was safe and efficacious as a bridge to liver transplant.

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Section: Discussionmentioning

confidence: 99%

Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant

et al. 2019

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“…38 SGA can also be insensitive for the detection of malnutrition in overweight/obese patients and compensated cirrhotic patients. 6,39 Thus, the PA arises as an alternative.…”

Section: Discussionmentioning

confidence: 99%

“…4 Furthermore, malnutrition appears to be associated with adverse clinical outcomes and mortality. 5,6,7,8 However, even with a high prevalence, malnutrition is often not diagnosed at admission to the hospital and may not be appropriately recognized in its earlier stages. 9 Hydric changes by the presence of edema and ascites are factors that can lead to underdiagnosis, reinforcing the importance of using appropriate assessment tools.…”

Section: Introductionmentioning

confidence: 99%

“…Malnutrition is a common complication of cirrhosis and has been reported in >50% of patients with decompensated disease 4 . Furthermore, malnutrition appears to be associated with adverse clinical outcomes and mortality 5,6,7,8 . However, even with a high prevalence, malnutrition is often not diagnosed at admission to the hospital and may not be appropriately recognized in its earlier stages 9 .…”

Section: Introductionmentioning

confidence: 99%

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Phase Angle Is an Independent Predictor of 6‐Month Mortality in Patients With Decompensated Cirrhosis: A Prospective Cohort Study

et al. 2020

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Background: This study aimed to evaluate the nutrition status through phase angle (PA) and its association with mortality in patients with decompensated cirrhosis. Methods: A prospective cohort study was performed with hospitalized decompensated cirrhotic patients. Nutrition status was assessed by PA, bioelectrical impedance vector analysis (BIVA), and Subjective Global Assessment (SGA) within 72 hours of hospital admission. The best PA cutoff point for malnutrition diagnosis was determined by ROC curve analysis, considering the SGA as the reference standard. Predictors of 6-month mortality were identified using Cox proportional hazards models, adjusted for Child-Pugh and MELD scores, and hepatocellular carcinoma. Results: This study included 97 patients, 63% male (n = 61), with a mean age of 60.1 ± 10.3 years. The median follow-up time of patients was 11.2 months (IQR, 2.4-21). Overall mortality was 58.8% (n = 57) and 6-month mortality was 35.1% (n = 34). Nutrition assessment according to BIVA indicated a risk for cachexia and normal hydration. Patients with values of PA ≤5.52°were considered malnourished. Malnourished patients according to PA (58.8%, n = 57) had a higher risk of 6-month mortality (HR = 3.44; 95% CI, 1.51-7.84; P = .003), and each increase of 1°in PA values was associated with a reduction of 53% in 6-month mortality risk. Conclusions: The PA is an independent predictor of 6-month mortality in patients with decompensated cirrhosis. Therefore, PA may be useful to assess the nutrition status and identify patients at the highest risk of mortality in clinical practice.

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“…Hence, muscle mass evaluation is indispensable in this context. Unfortunately, current exams are still inefficient in detecting functionality, and assessing protein synthesis and proteolysis [29,36].…”

Section: Discussionmentioning

confidence: 99%

Nutritional assessment, handgrip strength and adductor pollicis muscle thickness in patients with chronic viral hepatitis

Cortez

Almeida

Corrêa

et al. 2020

Clinical Nutrition Experimental

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Results: According to the SGA, one-third were considered at nutritional risk (SGA-B). Nutritional risk was found in 59.4%, 65.2% and 88% based on HGS, mid-arm muscle circumference (MAMC) and APMT, respectively. The dominant APMT obtained a mean of 17.2 ± 5.4 mm vs 16.2 ± 4.6 mm of the non-dominant hand. On the other hand, the dominant HGS had a mean of 27.3 ± 11.2 vs 24.2 ± 11.0 of the nondominant HGS. APMT and HGS values for any limb were significantly higher in males, but below thresholds patterns described for any gender. The HGS of both hands were correlated with sex, age, weight, height, MAMC, tricipital skinfold and APMT (p < 0.05). In multivariate linear regression, the model that best fit an exploratory analysis included: age, sex, height, MAMC, tricipital skinfold, and dominant APMT. Conclusion: There was a higher nutritional risk in patients with stable CVH when variables dependent of muscle mass were analyzed. APMT was an independent parameter to predict HGS value. We encourage malnutrition screening based on anthropometry, HGS and APMT, since SGA is not such a reliable tool for CVH.

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Combined nutritional assessment methods to predict clinical outcomes in patients on the waiting list for liver transplantation

Cited by 20 publications

References 52 publications

Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant

Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant

Phase Angle Is an Independent Predictor of 6‐Month Mortality in Patients With Decompensated Cirrhosis: A Prospective Cohort Study

Nutritional assessment, handgrip strength and adductor pollicis muscle thickness in patients with chronic viral hepatitis

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