Exercise capacity of cirrhotic patients with hepatopulmonary syndrome

Faustini-Pereira, José L.; Homercher-Galant, Lucas; García, Eduardo; Brandão, Ajácio Bandeira de Mello; Marroni, Cláudio Augusto

doi:10.1016/s1665-2681(19)31276-1

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…In this way, the performance of cirrhotic patients with and with no HPS was compared, verifying that this hypothesis was relevant. ( 20 )…”

Section: Discussionmentioning

confidence: 99%

“…Manovacuometry, 6MWT, and the treadmill stress test were also done as per the methodology used in our previous study. ( 20 ) The first followed the rules of the American Thoracic Society (ATS); the second, the system and values of normalcy recommended by the Brazilian Society of Pneumology and Phthisiology (SBPT); and the third, according to the regulations established by the American College of Sports Medicine (ACSM). ( 21 - 24 )…”

Section: Methodsmentioning

confidence: 99%

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Ventilatory support and hospital stay after liver transplant in cirrhotic patients with hepatopulmonary syndrome

Pereira

Galant

García

et al. 2017

Einstein (São Paulo)

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Objective To compare mechanical ventilation time, need for non-invasive ventilation, length of intensive care unit stay, and hospital stay after liver transplant in cirrhotic patients with and with no diagnosis of hepatopulmonary syndrome.Methods This was a prospective cohort study with a convenience sample of 178 patients (92 with hepatopulmonary syndrome) who were diagnosed as alcoholic or hepatitis C virus cirrhosis. The statistical analysis included Kolmogorov-Smirnov test and Students t test. Data were analyzed using SPSS version 16.0, and p values <0.05 were considered significant.Results Out of 178 patients, 90 underwent transplant (48 with no hepatopulmonary syndrome). The Group diagnosed with Hepatopulmonary Syndrome had longer mechanical ventilation time (19.5±4.3 hours versus 12.5±3.3 hours; p=0.02), an increased need for non-invasive ventilation (12 versus 2; p=0.01), longer intensive care unit stay (6.7±2.1 days versus 4.6±1.5 days; p=0.02) and longer hospital stay (24.1±4.3 days versus 20.2±3.9 days; p=0.01).Conclusion Cirrhotic patients Group diagnosed with Hepatopulmonary Syndrome had higher mechanical ventilation time, more need of non-invasive ventilation, as well as longer intensive care unit and hospital stay.

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“…In this way, the performance of cirrhotic patients with and with no HPS was compared, verifying that this hypothesis was relevant. ( 20 )…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ventilatory support and hospital stay after liver transplant in cirrhotic patients with hepatopulmonary syndrome

Pereira

Galant

García

et al. 2017

Einstein (São Paulo)

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“…In cirrhotic patients, there is insufficient glycogen due to limitations in hepatic synthesis, which increases the use of amino acids as an energy source and causes an acceleration in the decomposition of skeletal muscle to release amino acids, which results in a loss of muscle mass. These changes limit muscle functioning and negatively affect the performance of daily activities[ 126 ].…”

Section: Functional Limitations In Cirrhotic Patientsmentioning

confidence: 99%

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

Ca¹,

Am²,

Sa³

et al. 2018

WJG

113

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Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

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“…This test has recently been used to identify candidates for liver transplantation [7] and to evaluate the risk of mortality in cirrhosis. It has also been associated with the occurrence of the hepatopulmonary syndrome [8,9]. J Gastrointestin Liver Dis, March 2021 Vol.…”

Section: Introductionmentioning

confidence: 99%

Six-Minute Walking Test as a Predictor of Clinical Decompensation in Patients with Cirrhosis

Henrique

Malaguti

Limonge

et al. 2021

JGLD

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Background and Aims: The 6-minute walk test (6MWT) is a measure of the overall functional capacity and is associated with the risk of mortality in patients with liver cirrhosis and in those listed for liver transplantation. Nevertheless, physical performance has not yet been established as a predictor of the risk of clinical decompensation in patients with cirrhosis. We aimed to determine the capacity of the 6MWT to predict the clinical decompensation in patients with cirrhosis after 1 year of follow-up. Methods: This prospective cohort study included patients with compensated cirrhosis of several etiologies. All participants had stable clinical conditions for at least 6 months prior to baseline. At baseline, patients performed the 6MWT and were followed up for 1 year to detect the decompensation outcomes. Results: A total of 55 participants completed the evaluation and follow-up. The mean age was 56.3±10.5 years, and 65% were men. Around 65.4% were classified as Child-Pugh class A. In the receiver operating characteristic analysis, a walking distance ≤ 401.8 m during the 6MWT was set as the threshold for predicting clinical decompensation with 64% sensitivity and 82% specificity. Kaplan-Meier curve analysis revealed that patients who covered a distance of < 401.8 m during the test had a decompensation-free outcome rate of 30% as compared to the rate of 75% of those who walked > 401.8 m (p<0.001). Conclusions: The 6MWT was a significant predictor of clinical decompensation in patients with cirrhosis. A cutoff of 401.8 m was related to an increased risk of clinical decompensation in cirrhotic patients with a stable clinical condition at baseline. The 6MWT should be added to the clinical assessment of the cirrhotic population.

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Exercise capacity of cirrhotic patients with hepatopulmonary syndrome

Cited by 20 publications

References 22 publications

Ventilatory support and hospital stay after liver transplant in cirrhotic patients with hepatopulmonary syndrome

Ventilatory support and hospital stay after liver transplant in cirrhotic patients with hepatopulmonary syndrome

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

Six-Minute Walking Test as a Predictor of Clinical Decompensation in Patients with Cirrhosis

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