Interventions to improve physical function and prevent adverse events in cirrhosis

Trivedi, Hirsh D.; Tapper, Elliot B.

doi:10.1093/gastro/gox042

Cited by 37 publications

(44 citation statements)

References 65 publications

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“…Second, by identifying patients with suboptimal performance on cognitive testing, we may initiate therapeutic trials—including lactulose—that could have the potential to improve quality of life . Third, interventions for patients with frailty, such as improved nutritional support and physical therapy, may result in improvements in quality of life . These interventions have been shown to be effective in improving HRQOL in patients with advanced cirrhosis on the liver transplant waiting list, but have not been studied in patients with Child A cirrhosis, a more clinically stable population in whom such interventions are easier to implement.…”

Section: Discussionmentioning

confidence: 99%

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

et al. 2019

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Cirrhosis is associated with disabling symptoms and diminished health‐related quality of life (HRQOL). However, for patients with compensated disease, data are limited regarding associations with poor patient‐reported outcomes (PROs). We prospectively enrolled 300 patients with cirrhosis and portal hypertension without a history of hepatic encephalopathy (HE) and reviewed medical and pharmacy records. We characterized determinants of PROs using the 8‐item Short‐Form Health Survey (SF‐8) scale (0‐100) and sleep quality using the Pittsburgh Sleep Quality Index (PSQI; poor sleep >5). Disability and frailty measures were assessed using activities of daily living (ADLs), falls, hand‐grip, and chair‐stands. Cognitive function was measured using weighted‐lures from the Inhibitory Control Test (ICT). The median age of our cohort was 60 (interquartile range [IQR], 52‐66) years, 56.3% were male, and 70% Child class A. All patients had portal hypertension, 76% had varices, and 41% had a history of ascites (predominantly well controlled). The median Model for End‐Stage Liver Disease with Sodium (MELD‐Na) score was 9 (IQR, 7‐13). The overall median SF‐8 was 70 (IQR, 54‐86). Multivariate analysis showed that after adjusting for age, sex, education, and MELD‐Na, performance on chair‐stands (9.28 HRQOL points [95% confidence interval {CI}, 4.76‐13.8] per 10‐stands), ADL dependence (–6.06 [–10.8 to –1.36]), opiate use (–5.01 [–7.84 to –2.19]), benzodiazepine use (–3.50 [–6.58 to –0.42]), and ICT performance (–0.10 [–0.20 to 0.001] per weighted‐lure) were significantly associated with HRQOL. Among patients completing the ICT, poor HRQOL (score <50) was significantly associated with chair‐stands (odds ratio [OR] per 10‐stands, 0.24; 95% CI [0.11‐0.56]) and weighted lures (OR per weighted‐lure, 1.01 [1.00‐1.03]). Poor sleep quality was associated with opiate use (OR, 2.85 [1.11‐7.29]) and lures (OR per‐lure, 1.03 [1.00‐1.05]). Conclusion: Disability, chair‐stand performance, cognitive dysfunction, as well as psychoactive medication use are significantly associated with PROs in patients with clinically stable cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

et al. 2019

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“…Previous studies indicated that exercise and nutritional therapy improve physical function and increase muscle mass in patients with chronic liver disease [ 17 , 18 ]; however, patients with non-alcoholic fatty liver disease and cirrhosis wait-listed for liver transplantation tend to have low levels of physical activity (PA) compared to healthy adults [ 19 , 20 ]. In addition, patients with severe liver cirrhosis and esophageal varices are limited in their ability to exercise [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Sarcopenia and Both Physical Activity and Lifestyle in Patients With Chronic Liver Disease

et al. 2018

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BackgroundSarcopenia can affect the prognosis of patients with cirrhosis or hepatocellular carcinoma. Exercise therapy and nutritional therapy are carried out to prevent processing sarcopenia. In addition, changing lifestyle is also important. However, there are only few reports on the physical activities (PAs) and lifestyle of chronic liver disease patients and their association with sarcopenia. The aim of this study is to examine the relationship between sarcopenia in patients with chronic liver disease and both PA and lifestyle.MethodsA total of 214 out-patients with chronic liver disease were enrolled into the present study. All patients were evaluated for with or without sarcopenia based on the sarcopenia diagnostic criteria of the Japan Society of Hepatology. Then, patient’s characteristics and laboratory parameters were divided into two groups with or without sarcopenia and compared. In continuous variable with significant difference in univariate analysis, cut-off value was calculated by receiver operating characteristic curve. We determined which factors were associated with sarcopenia in univariate analyses, and variables significant in the univariate analyses were entered in a multivariable logistic regression model.ResultsPatients with chronic liver disease had a prevalence of sarcopenia of 12.6% in this study. Sarcopenia patients were older (76.48 ± 6.69 versus 66.97 ± 11.19 years old; P < 0.01), had lower body mass index (BMI) (20.84 ± 2.44 versus 23.76 ± 3.72 kg/m2; P < 0.01), lower PA (6.6 (2.34 - 19.90) versus 16.5 (6.60 - 41.23) metabolic equivalents (METs)-h/week; P < 0.01) and longer total time sitting and lying on the day (7.43 ± 4.09 versus 5.68 ± 3.17 h/day; P = 0.01); retirement status (81.5% versus 48.1%; P < 0.01) and low frequency of driving (40% versus 20%; P = 0.01) were higher in sarcopenia patients than in non-sarcopenia patients. The independent predictive factors of sarcopenia, analyzed with logistic regression, were age (odds ratio (OR): 5.89, 95% confidence interval (CI): 2.15 - 16.20; P < 0.01), BMI (OR: 4.77, 95% CI: 1.87 - 12.10; P < 0.01) and PA (OR: 3.65, 95% CI: 2.15 - 16.20; P < 0.01).ConclusionSarcopenia patients’ lifestyle characteristics were longer sedentary time and low frequency of driving, high retirement. Independent predictive factors of sarcopenia were elderly, low BMI and low PA. For these patients, intervention in the lifestyle for prevention of sarcopenia may be effective for patients with chronic liver disease.

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“…Trivedi et al patients with cirrhosis to meet their daily dietary requirements, and hence, we recommend routine nutritional counseling in order to prevent malnourishment, which may further propagate osteoporosis and fracture risk. 37…”

Section: Dovepressmentioning

confidence: 99%

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Trivedi¹,

Danford²,

Goyes³

et al. 2020

CEG

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Primary biliary cholangitis (PBC) is a chronic, cholestatic condition associated with symptoms that directly impact the quality of life in those afflicted with the disease. In addition to pruritus and fatigue, patients with PBC may develop metabolic bone disease from reduced bone density, such as osteopenia and osteoporosis. Osteoporosis increases the risk of fractures, as well as morbidity and mortality. The prevalence of osteoporosis in PBC is expected to increase in conjunction with the rising prevalence of PBC as a whole. Timely diagnosis, prevention and management of osteoporosis are crucial in order to optimize the quality of life. There is a paucity of data evaluating the management of osteoporosis in PBC. The optimal timing for diagnosis and monitoring is not yet established and is guided by expert opinion. National guidelines recommend screening for osteoporosis at the time of diagnosis of PBC. Monitoring strategies are based on results of initial screening and individual risk factors for bone disease. Identifying reduced bone density is imperative to institute timely preventive and treatment strategies. However, treatment remains challenging as efficacious therapies are currently lacking. The data on treatment of osteoporosis in PBC are mostly extrapolated from postmenopausal osteoporosis literature. However, this data has not directly translated to useful treatment strategies for PBC-related osteoporosis, partly because of the different pathophysiological mechanisms of the two diseases. The lack of useful preventive measures and efficacious treatment strategies remains the largest pitfall that challenges the management of patients with PBC. In this review, we comprehensively outline the epidemiology, clinical implications and challenges, as well as management strategies of PBC-related osteoporosis.

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Interventions to improve physical function and prevent adverse events in cirrhosis

Cited by 37 publications

References 65 publications

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

Relationship Between Sarcopenia and Both Physical Activity and Lifestyle in Patients With Chronic Liver Disease

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

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