Muscle Mass Predicts Outcomes Following Liver Transplantation
Muscle Mass Predicts Outcomes Following Liver Transplantation
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DOI：
10.1002/lt.23724
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发表时间：
2013-11-01
影响因子：
4.6
通讯作者：
Fontes, Paulo
中科院分区：
文献类型：
--
作者：
DiMartini, Andrea;Cruz, Ruy J., Jr.;Fontes, Paulo
对于终末期肝病患者，常用的营养状况指数(即体重和体重指数)往往因液体超载(如腹水和外周水肿)而被夸大，从而导致对营养不良的漏诊。因为肌肉是体内最大的蛋白质储存库，对肌肉质量的估计可能是更可靠和有效的营养状态估计。因此，我们使用了338名肝移植(LT)患者的移植前计算机断层扫描数据，根据身体成分分析中常用的特定腹部横断面来确定肌肉和脂肪质量，并调查了这一测量方法对特定的肝移植后结果的贡献。我们发现，我们的大多数患者(68%)可以被定义为恶病质。对于男性来说，肌肉质量预测了许多重要的移植后结果，包括重症监护病房(ICU)住院时间、总住院时间(LOS)和插管天数。肌肉质量是一个重要的生存预测因子，也预测了对家的倾向与对其他设施的倾向。对于女性来说，肌肉质量预测了ICU住院时间、总损失和插管天数，但影响不大。肌肉质量并不能预测女性的生存或性情。总之，由于移植前肌肉质量与许多重要的术后结果相关，我们在移植前干预的背景下讨论了这些发现，以改善或维持手术前的肌肉质量。《肝脏移植》19：1172-1180,2013。(C)2013年AASLD。
For patients with end-stage liver disease, commonly used indices of nutritional status (ie, body weight and body mass index) are often inflated because of fluid overload (ie, ascites and peripheral edema), and this results in an underdiagnosis of malnutrition. Because muscle is the largest protein reservoir in the body, an estimate of the muscle mass may be a more reliable and valid estimate of nutritional status. Therefore, we used pretransplant computed tomography data for 338 liver transplantation (LT) candidates to identify muscle and fat mass on the basis of a specific abdominal transverse section commonly used in body composition analyses, and we investigated the contribution of this measure to specific post-LT outcomes. We found that the majority of our patients (68%) could be defined as cachectic. For men, muscle mass predicted many important posttransplant outcomes, including intensive care unit (ICU) stay, total length of stay (LOS), and days of intubation. Muscle mass was a significant predictor of survival and also predicted disposition to home versus another facility. For women, muscle mass predicted ICU stay, total LOS, and days of intubation, but the effect was modest. Muscle mass did not predict survival or disposition for women. In conclusion, because pretransplant muscle mass is associated with many important postoperative outcomes, we discuss these findings in the context of possible pretransplant interventions for either improving or sustaining muscle mass before surgery. Liver Transpl 19:1172-1180, 2013. (c) 2013 AASLD.