Clinical utility of the Liver Frailty Index for predicting muscle atrophy in chronic liver disease patients with hepatocellular carcinoma
Clinical utility of the Liver Frailty Index for predicting muscle atrophy in chronic liver disease patients with hepatocellular carcinoma
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DOI：
10.1111/hepr.13453
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发表时间：
2019-12-29
影响因子：
4.2
通讯作者：
Torimura, Takuji
中科院分区：
文献类型：
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作者：
Hirota, Keisuke;Kawaguchi, Takumi;Torimura, Takuji
目的肌肉萎缩是慢性肝病(CLD)和肝细胞癌(HCC)患者的预后因素。肝脏脆弱指数(LFI)是一种简单的身体功能测试；然而，LFI和肌肉质量之间的联系尚不清楚。我们的目的是研究LFI在预测慢性肝病合并肝细胞癌患者肌肉萎缩方面的应用。方法选择慢性肝病合并肝癌患者138例，年龄77岁，男女比例为34.8%/65.2%。以骨骼肌指数评估肌肉质量，将患者分为肌萎缩组(n=109)和非肌萎缩组(n=29)。采用LFI评定体力衰竭程度。通过受试者工作特性分析，确定了LFI预测肌肉萎缩的最佳临界值。结果肌萎缩组Pre-File/Flail的发生率显著高于非肌萎缩组(87.2%vs.58.6%，P=0.0005)。Logistic回归分析显示，女性和体弱前/体弱是肌萎缩的独立危险因素(体前/体弱，OR 3.601，95%CI 1.381~9.400，P=0.0088)。在握力正常的患者中，71.1%的患者处于前虚弱/虚弱状态，其中82.8%的患者出现肌肉萎缩。受试者操作特征统计提供的曲线下面积为0.74，LFI临界值为2.94(敏感性88.06%，特异性52.17%，准确性77.91%)。结论Pre-Frail/Frail是CLD合并肝细胞癌患者肌肉萎缩的独立因素。此外，LFI预测肌肉萎缩的敏感性很高，即使在握力正常的患者中也是如此。因此，LFI可能是肝细胞癌CLD患者肌肉萎缩的一种有用的筛查工具。
Aim Muscle atrophy is a prognostic factor for patients with chronic liver disease (CLD) and hepatocellular carcinoma (HCC). The Liver Frailty Index (LFI) is a simple physical function test; however, an association between LFI and muscle mass remains unclear. We aimed to investigate the utility of LFI for predicting muscle atrophy in CLD patients with HCC. Methods We enrolled 138 CLD patients with HCC (aged 77 years, female/male 34.8%/65.2%). Muscle mass was assessed by skeletal muscle index, and patients were classified into the muscle atrophy group (n = 109) or the non-muscle atrophy group (n = 29). Physical frailty was assessed by LFI. The optimal cut-off value of LFI for predicting muscle atrophy was identified by receiver operating characteristic analysis. Results In the muscle atrophy group, the prevalence of pre-frail/frail was significantly higher than the non-muscle atrophy group (87.2% vs. 58.6%, P = 0.0005). In the logistic regression analysis, being female and pre-frail/frail were identified as independent factors associated with muscle atrophy (pre-frail/frail; OR 3.601, 95% CI 1.381-9.400, P = 0.0088). In patients with normal grip strength, 71.1% of patients were pre-frail/frail, in which 82.8% of patients showed muscle atrophy. Receiver operating characteristic statistics provided an area under the curve of 0.74, and an LFI cut-off value of 2.94 for predicting muscle atrophy (sensitivity 88.06%, specificity 52.17%, accuracy 77.91%). Conclusions We showed that pre-frail/frail was an independent factor for muscle atrophy in CLD patients with HCC. Furthermore, LFI predicted muscle atrophy with high sensitivity, even in patients with normal grip strength. Thus, LFI might be a useful screening tool for muscle atrophy in CLD patients with HCC.