Functional decline in patients with cirrhosis awaiting liver transplantation: Results from the functional assessment in liver transplantation (FrAILT) study.
Functional decline in patients with cirrhosis awaiting liver transplantation: Results from the functional assessment in liver transplantation (FrAILT) study.
复制标题
DOI：
10.1002/hep.28316
复制
发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Feng S
中科院分区：
文献类型：
--
作者：
Lai JC;Dodge JL;Sen S;Covinsky K;Feng S
肝硬化的特点是肌肉减少症和营养不良，导致进行性功能衰退。我们的目的是客观地衡量等待肝移植（LT）的肝硬化患者的功能下降及其与等待名单死亡率的关系。在单一中心连续列出实验室 MELD ≥ 12 的成人在每次门诊就诊时均使用短体能测试 (SPPB；0 = 受损至 12 = 健壮) 进行功能状态评估，包括步态、椅子站立和平衡测试。联合线性时间事件分析模拟了身体机能纵向轨迹对候补死亡率（=死亡/因病重而无法进行 LT 而被除名）的同时影响。其中包括 309 名 LT 候选人。实验室MELD中位数为15，血清白蛋白为3.0 g/dL，28%有腹水，18%有肝性脑病，83%为Child B/C级。中位随访 14 个月后，15% 的患者死亡/被除名，28% 的患者接受了 LT。等待名单上的平均身体功能每 3 个月恶化：握力 -0.38 公斤，步态 -0.05 米/秒，椅子站立 0.03 秒，SPPB 分 -0.16。在根据 MELD-Na、白蛋白、肝细胞癌和基线身体功能调整后的身体机能纵向轨迹和候补死亡率联合模型中，每个身体功能测量的纵向轨迹与候补死亡率显着相关：握力[风险比 (HR)=0.89，95%CI=0.83-0.95]、步态（HR 0.72， 95%CI=0.62–0.84)，椅子站立(HR=1.17，95%CI=1.09–1.25)，SPPB<10(HR=1.45，95%CI=1.15–2.20)。尽管等待时间较短且 MELD 基线较低，但 LT 候选人在等待名单上经历了显着的功能下降。身体机能下降与死亡/退市风险增加相关，与肝病严重程度无关。
Cirrhosis is characterized by sarcopenia and malnutrition, leading to progressive functional decline. We aimed to objectively measure functional decline in cirrhotics awaiting liver transplantation (LT) and its association with wait-list mortality. Consecutive adults listed for LT with laboratory MELD≥12 at a single center underwent functional status assessments at every outpatient visit using the Short Physical Performance Battery (SPPB; 0=impaired to 12=robust) consisting of gait, chair stands, and balance tests. Joint linear time-to-event analyses modeled the simultaneous impact of longitudinal trajectory of physical function on wait-list mortality (=death/delisted for being too sick for LT). Included were 309 LT candidates. Median laboratory MELD was 15, serum albumin was 3.0 g/dL, 28% had ascites, 18% hepatic encephalopathy, and 83% were Child class B/C. At a median follow-up of 14 months, 15% died/were delisted and 28% underwent LT. Average physical function worsened per 3 months on the wait-list: −0.38 kg in grip strength, −0.05 meters/second in gait, 0.03 seconds in chair stands, and −0.16 SPPB points. In joint models of longitudinal trajectories of physical function and wait-list mortality adjusted for MELD-Na, albumin, hepatocellular carcinoma, and baseline physical function, the longitudinal trajectories of each physical function measure were significantly associated with wait-list mortality: grip [hazard ratio (HR)=0.89, 95%CI=0.83–0.95], gait (HR 0.72, 95%CI=0.62–0.84), chair stands (HR=1.17, 95%CI=1.09–1.25), and SPPB<10 (HR=1.45, 95%CI=1.15–2.20). LT candidates experience significant functional decline on the wait-list, despite modest wait-time and low baseline MELD. Decline in physical function is associated with an increased risk of death/delisting, independent of liver disease severity.