Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score.
Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score.
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DOI：
10.1002/jcsm.12333
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Kim MY
中科院分区：
文献类型：
--
作者：
Kang SH;Jeong WK;Baik SK;Cha SH;Kim MY
据报道，肌肉减少症是一种预后因素。我们评估了肌减少症对肝硬化患者常规预后因素[终末期肝病模型（MELD）评分、Child-Turcotte-Pugh（CTP）评分、肝静脉压差（HVPG）]的影响。总体而言，452例肝硬化患者按MELD评分（低评分< 15，高评分≥ 15）、CTP分级和HVPG [无临床意义的门静脉高压（CSPH），6-9 mmHg; CSPH，10-19 mmHg;极重度PH，≥20 mmHg]分层。将作为肌肉减少症标志物的L3骨骼肌指数细分为四分位数（47.01-52.25-58.22 cm 2/m2）。42%（190/452）的患者出现肌肉减少症。在21.2个月的中位随访期内，肌肉减少症与死亡率相关（调整后的风险比= 2.253，P < 0.001），特别是在肝硬化的代偿期和早期失代偿期，但在晚期失代偿期则不然;低（P < 0.001）和高（P = 0.095）MELD评分; CTP A级（P = 0.034）、B（P < 0.001）和C（P = 0.205）;非CSPH（P = 0.018）、CSPH（P < 0.001）和极重度PH（P = 0.846）。在肌肉减少症的四分位数中，MELD评分、CTP分级和HVPG是非肌肉减少症死亡率的独立预测因子，但不是重度肌肉减少症死亡率的独立预测因子（MELD，P = 0.182; CTP，P = 0.187; HVPG，P = 0.077）。肌肉减少症与代偿期和早期失代偿期肝硬化的死亡率相关，现有的传统预后因素对严重肌肉减少症的价值有限。因此，将肌肉减少症纳入常规预后因素具有附加价值，特别是在代偿期和早期失代偿期肝硬化中。根据肌肉减少症对预后因素进行分类有助于更好地评估肝硬化的预后。
Sarcopenia has been reported as a prognostic factor. We evaluated the impact of sarcopenia to the conventional prognostic factors [Model for End‐Stage Liver Disease (MELD) score, Child–Turcotte–Pugh (CTP) score, hepatic venous pressure gradient (HVPG)] in cirrhosis. Overall, 452 patients with cirrhosis were stratified by MELD score (low < 15, high ≥ 15), CTP class, and HVPG [non‐clinically significant portal hypertension (CSPH), 6–9 mmHg; CSPH, 10–19 mmHg; extremely severe PH, ≥20 mmHg]. L3 skeletal muscle index as marker of sarcopenia was subdivided into quartiles (47.01–52.25–58.22 cm2/m2). Among the patients, 42% (190/452) presented with sarcopenia. During a median follow‐up period of 21.2 months, sarcopenia was associated with mortality (adjusted hazard ratio = 2.253, P < 0.001) and specifically with compensated and early decompensated stages of cirrhosis, but not with advanced decompensated stages; low (P < 0.001) and high (P = 0.095) MELD scores; CTP classes A (P = 0.034), B (P < 0.001), and C (P = 0.205); and non‐CSPH (P = 0.018), CSPH (P < 0.001), and extremely severe PH (P = 0.846). In quartiles of sarcopenia, MELD score, CTP class, and HVPG were independent predictors of mortality in non‐sarcopenia, but not in severe sarcopenia (MELD, P = 0.182; CTP, P = 0.187; HVPG, P = 0.077). Sarcopenia is associated with mortality in compensated and early decompensated cirrhosis, and existing conventional prognostic factors had limited value in severe sarcopenia. Therefore, incorporating sarcopenia in the conventional prognostic factors had added value, particularly in compensated and early decompensated cirrhosis. Subclassification of prognostic factors according to sarcopenia may help to better assess the prognosis of cirrhosis.
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DOI：
10.1002/lt.24750
发表时间：
2017-05
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
--
作者：
Carey EJ;Lai JC;Wang CW;Dasarathy S;Lobach I;Montano-Loza AJ;Dunn MA;Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
通讯作者：
Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
影响因子：
4.6
作者：
Merion, RM;Wolfe, RA;Held, PJ
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Held, PJ
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13.5
作者：
Jung, Kyu Sik;Kim, Seung Up;Han, Kwang-Hyub
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4.6
作者：
Freeman, RB;Wiesner, RH;Teperman, L
通讯作者：
Teperman, L
影响因子：
8.9
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Kim JH;Kim JM;Cho YZ;Na JH;Kim HS;Kim HA;Kang HW;Baik SK;Kwon SO;Cha SH;Kim YJ;Kim MY
通讯作者：
Kim MY