Identification and prognostic impact of malnutrition in a population screened for liver transplantation

Basar

et al. 2021

APMC

Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B & C patients were found to have more significant malnourished states.

Section: Resultsmentioning

confidence: 97%

Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Basar

et al. 2021

APMC

“…Мальнутриция и саркопения наблюдаются у 20-50% больных с циррозом печени [6]. При этом у женщин чаще развивается дефицит жировых отложениях, в то время как мужчины быстрее теряют мышечную ткань.…”

Section: основные определенияunclassified

“…При этом у женщин чаще развивается дефицит жировых отложениях, в то время как мужчины быстрее теряют мышечную ткань. Они ассоциированы с более высокой частотой повышенной восприимчивости к инфекции, печеночной энцефалопатии (ПЭ), асцита, а также являются независимыми предикторами снижения выживаемости при ХЗП [6]. Приблизительно 75% пациентов с ПЭ имеют белково-энергетическую недостаточность от умеренной до тяжелой степени [7].…”

Section: основные определенияunclassified

Nutritional support for chronic liver disease patients

Осипенко¹,

Жук²

2020

jour

Нутритивная поддержка при хронических заболеваниях печени | Nutritional support for chronic liver disease patients РезюмеОдним из важнейших немедикаментозных методов терапии пациентов с хроническими заболеваниями печени (ХЗП) является нутритивная поддержка. В лекции авторы рассматривают актуальность этого метода терапии, способы выявления нарушений питания у больных с ХЗП и вопросы лечебного питания. Исследования последних лет демонстрируют, что нутритивная поддержка при ХЗП является быстро развивающейся областью медицины и объектом растущего клинического интереса. Следует признать, что исследования в данной области базируются на общепринятых рекомендациях для пациентов с другими нозологиями. Поэтому без ответов остаются многие вопросы, что открывает просторы для новых исследований.

Section: Introductionmentioning

confidence: 99%

“…In this scenario, recent studies have shown that the efficacy of a clinical screening tool for malnutrition such as the subjective global assessment (SGA), bioelectrical impedance analysis (BIA), or dual-energy X-ray absorptiometry (DXA) were unsatisfactory in the setting of WL for LT, raising the need of new tools to optimize the prediction of this condition. [8][9][10] Cystatin C (CysC) is a low molecular weight protein, which after glomerular filtration is fully catabolized in the proximal renal tubule and is not returned to blood. CysC has been proposed as an alternative biomarker to estimate renal function, because it does not appear to be affected by patients' muscle mass, protein deficiency, gender disparity, or hyperbilirubinemia.…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

et al. 2022

Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio[OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR:1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007).The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.