Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

Kamimura, Kenya; Sakamaki, Akira; Kamimura, Hiroteru; Setsu, Toru; Yokoo, Takeshi; Takamura, Masaaki; Terai, Shuji

doi:10.3748/wjg.v25.i15.1817

Cited by 16 publications

(14 citation statements)

References 47 publications

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“…Older patients use significantly greater health care resources than younger patients, especially during hospitalization [ 3 , 4 , 5 ]. In the setting of increasing longevity in different societies, the proportion of hospitalized older adults with cirrhosis, compared to those who are younger, continues to increase [ 6 , 7 , 8 ]. Aging adversely affects hepatic function, responses to injury, and complications of cirrhosis [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

et al. 2021

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Background: There are limited data on outcomes of older patients with chronic diseases. Skeletal muscle loss of aging (primary sarcopenia) has been extensively studied but the impact of secondary sarcopenia of chronic disease is not as well evaluated. Older patients with chronic diseases have both primary and secondary sarcopenia that we term compound sarcopenia. We evaluated the clinical impact of compound sarcopenia in hospitalized patients with cirrhosis given the increasing number of patients and high prevalence of sarcopenia in these patients. Design: The Nationwide Inpatients Sample (NIS) database (years 2010–2014) was analyzed to study older patients with cirrhosis. Since there is no universal hospital diagnosis code for “muscle loss”, we used a comprehensive array of codes for “muscle loss phenotype” in the international classification of diseases-9 (ICD-9). A randomly selected 2% sample of hospitalized general medical population (GMP) and inpatients with cirrhosis were stratified into 3 age groups based on age-related changes in muscle mass. In-hospital mortality, length of stay (LoS), cost of hospitalization (CoH), comorbidities and discharge disposition were analyzed. Results. Of 517,605 hospitalizations for GMP and 106,835 hospitalizations for treatment of cirrhosis or a cirrhosis-related complication, 207,266 (40.4%) GMP and 29,018 (27.7%) patients with cirrhosis were >65 years old, respectively. Muscle loss phenotype in both GMP and inpatients with cirrhosis 51–65 years old and >65 years old was significantly (p < 0.001 for all) associated with higher mortality, LoS, and CoH compared to those ≤50 years old. Patients >65 years old with cirrhosis and muscle loss phenotype had higher mortality (adjusted OR: 1.06, 95% CI [1.04, 1.08] and CoH (adjusted odds ratio (OR): 1.10, 95% confidence interval (CI) [1.04, 1.08])) when compared to >65 years old GMP with muscle loss phenotype. Muscle loss in younger patients with cirrhosis (≤50 years old) was associated with worse outcomes compared to GMP >65 years old. Non-home discharges (nursing, skilled, long-term care) were more frequent with increasing age to a greater extent in patients with cirrhosis with muscle loss phenotype for each age stratum. Conclusion: Muscle loss is more frequent in older patients with cirrhosis than younger patients with cirrhosis and older GMP. Younger patients with cirrhosis had clinical outcomes similar to those of older GMP, suggesting an accelerated senescence in cirrhosis. Compound sarcopenia in older patients with cirrhosis is associated with higher inpatient mortality, increased LoS, and CoH compared to GMP with sarcopenia.

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Section: Introductionmentioning

confidence: 99%

Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

et al. 2021

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“…This finding can be explained by the lower life expectancy, higher comorbidities, and expensive cirrhosis treatments. 50,51 More ever their low level of awareness may also delay the diagnosis and treatment. 39 Strengths and limitations.…”

Section: Discussionmentioning

confidence: 99%

“…In almost all societies, the health system cares more about people with lower age and high physical condition. This finding can be explained by the lower life expectancy, higher comorbidities, and expensive cirrhosis treatments 50,51 . More ever their low level of awareness may also delay the diagnosis and treatment 39 …”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national burden and quality of care index of liver cirrhosis by cause from global burden of disease 1990–2019

Gorgani

Esfahani

Ghamari

et al. 2022

J of Gastro and Hepatol

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Background and Aim Cirrhosis and other chronic liver diseases are complex disorders with a known burden. Currently health systems have different approaches to dealing with this issue. The objective of this study is to describe the burden attributed to and quality of care for cirrhosis and other chronic liver diseases. Methods Data of cirrhosis and other chronic liver diseases extracted from Global‐Burden‐of‐Diseases 2019. Four indicators, including mortality to incidence ratio, prevalence to incidence ratio, disability‐adjusted‐life‐years (DALYs) to prevalence ratio, and years‐of‐life‐lost (YLLs) to years‐lived‐with‐disability (YLDs) ratio, were defined and combined by the principal‐components‐analysis to construct the Quality‐of‐Care‐Index (QCI). Results The global QCI of cirrhosis increased from 71.0 in 1990 to 79.3 in 2019. The QCI showed a favorable situation in higher SDI countries compared with lower SDI countries, with a QCI of 86.8 in high SDI countries and 60.1 in low SDI countries. The highest QCI was found in Western Pacific Region (90.2), and the lowest was for African Region (60.4). Highest QCI belonged to the 50–54 age group (99.5), and the lowest was for the 30.34 age group (70.9). Among underlying causes of cirrhosis, the highest QCI belonged to alcohol use, followed by hepatitis C and NAFLD with QCIs of 86.1, 85.3, and 81.1. Conclusions There was a considerable variation in the QCI of cirrhosis and other chronic liver diseases. Countries with low QCI, mainly located in developing regions, need organized action to control the burden of cirrhosis and its underlying causes and improve their quality of care.

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“…In age and gender subgroup analyses, older patients and men with DM had significantly greater evidence of HE (p-value 0.02 and 0.03, respectively). Multivariate analysis showed that DM (p-value 0.03) and older age (p-value 0.006) were independently related to HE [ 12 ], as increased transient time secondary to autonomic dysfunction in diabetes that often occurs in elderly patients may lead to HE [ 13 ], whereas the association of gender was non-significant [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Type 2 Diabetes and Hepatic Encephalopathy in Chronic Liver Disease Patients

Usmani

Rahman

Jamal

et al. 2021

Cureus

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Background Hepatic encephalopathy (HE) is an important complication of hepatic cirrhosis and is an independent predictor of mortality in patients with cirrhosis. The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Diabetes leads to increased gastric transit and orocecal time, increased glutamase activity, and intestinal bacterial overgrowth, which may increase intestinal ammonia production. Thus, we speculated that diabetes mellitus (DM) might predispose cirrhotic patients to development and/or exacerbation of HE. The main purpose of this study is to determine the association of DM with severe HE in patients with chronic liver disease (CLD). Methods This case-control study (122 cases and 122 controls) was conducted for 6 months on patients who fulfilled the inclusion criteria and were selected from the Medical department, Abbasi Shaheed Hospital, Karachi, after taking informed consent. Demographic data were presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Chi-square was applied and the odds ratio (OR) was calculated taking a p-value of ≤ 0.05 as statistically significant. Results Out of a total of 244 patients, 122 patients had CLD with DM (case group) and 122 participants had CLD without DM (control group). The mean and standard deviation of age in the case and control groups in our study was 43.29±3.79 and 45.49±5.40. The mean and standard deviation of the duration of disease in the case and control groups in our study was 3.18±1.22 and 3.72±1.36. Males were 53 (43.44%) and 56 (45.10%) in the case and control groups, whereas females were 69 (56.56%) and 66 (54.10%) in the case and control groups, respectively. Out of 122 patients in the case group, 73 (59.84%) and 49 (40.16%) patients developed and did not develop severe HE, respectively. Out of 122 patients in the control group, 50 (40.98%) and 72 (59.02%) patients developed and did not develop severe HE, respectively. Binary logistic regression analysis showed an association of severe HE with DM (p-value: 0.93, OR: 1.033, 95% CI: 0.586-1.599). Conclusion This study demonstrates that HE is a common occurrence in CLD patients. There was not a direct relationship of DM with the severity of HE was observed. However, further research with larger sample size and involving a multicenter setting is warranted.

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Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

Cited by 16 publications

References 47 publications

Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

Global, regional, and national burden and quality of care index of liver cirrhosis by cause from global burden of disease 1990–2019

Association of Type 2 Diabetes and Hepatic Encephalopathy in Chronic Liver Disease Patients

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