Enhancing ACLF prediction by integrating sarcopenia assessment and frailty in liver transplant candidates on the waiting list.

Background & Aims: Malnutrition, sarcopenia, and frailty are prevalent in cirrhosis. We aimed to assess the correlation between assessment tools for malnutrition, sarcopenia, and frailty in patients on the liver transplant (LT) waiting list (WL), and to identify a predictive model for acute-on-chronic liver failure (ACLF) development. Methods: This prospective single-center study enrolled consecutive patients with cirrhosis on the WL for LT (May 2019-November 2021). Assessments included subjective global assessment, CT body composition, skeletal muscle index (SMI), ultrasound thigh muscle thickness, sarcopenia HIBA score, liver frailty index (LFI), hand grip strength, and 6-minute walk test at enrollment. Correlations were analyzed using Pearson's correlation. Competing risk regression analysis was used to assess the predictive ability of the liver- and functional physiological reserve-related variables for ACLF. Results: A total of 132 patients, predominantly with decompensated cirrhosis (87%), were included. Our study revealed a high prevalence of malnutrition (61%), sarcopenia (61%), visceral obesity (20%), sarcopenic visceral obesity (17%), and frailty (10%) among participants. Correlations between the assessment tools for sarcopenia and frailty were poor. Sarcopenia by SMI remained prevalent when frailty assessments were not usable. After a median follow-up of 10 months, 39% of the patients developed ACLF on WL, while 28% experienced dropouts without ACLF. Multivariate analysis identified MELD-Na, SMI, and LFI as independent predictors of ACLF on the WL. The predictive model MELD-Na-sarcopenia-LFI had a C-statistic of 0.85. Conclusions: The poor correlation between sarcopenia assessment tools and frailty underscores the importance of a comprehensive evaluation. The SMI, LFI, and MELD-Na independently predicted ACLF development in WL. These findings enhance our understanding of the relationship between sarcopenia, frailty, and ACLF in patients awaiting LT, emphasizing the need for early detection and intervention to improve WL outcomes. Impact and implications: The relationship between sarcopenia and frailty assessment tools, as well as their ability to predict acute-on-chronic liver failure (ACLF) in patients on the liver transplant (LT) waiting list (WL), remains poorly understood. Existing objective frailty screening tests have limitations when applied to critically ill patients. The correlation between sarcopenia and frailty assessment tools was weak, suggesting that they may capture different phenotypes. Sarcopenia assessed by skeletal muscle index, frailty evaluated using the liver frailty index, and the model for end-stage liver disease-Na score independently predicted the development of ACLF in patients on the WL. Our findings support the integration of liver frailty index and skeletal muscle index assessments at the time of inclusion on the WL for LT. This combined approach allows for the identification of a specific patient subgroup with an increased susceptibility to ACLF, underscoring the importance of early implementation of targeted treatment strategies to improve outcomes for patients awaiting LT.

Chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) diagnosing equation in cirrhotic patients.

Cirrhotic patients can develop acute kidney injury (AKI), and chronic kidney disease (CKD). Therefore, renal functional evaluation is crucial in cirrhotic patients. However, serum creatinine and urea levels, as well as measured or estimated glomerular filtration rate is not reliable renal functional markers in these patients compared to other patient groups. In the present study, four original equations are designed and tested for screening chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) in stable cirrhotic patients. MATERIAL & METHOD: estimated GFR (CKD-EPI creatinine and cystatin equations) were recorded in 175 adult stable patients suffering from cirrhosis, and these patients were classified as presenting or not CKD and CKI after evaluation by two independent nephrologists. Based on these data, the variables with the significant discriminating capability to identify CKD and CKI (based on creatinine and cystatin) were detected by applying the Student's t-test for two independent groups, later confirmed by the lambda test of Wilks, in order to obtain the renal function equations. RESULTS: CKD equation (creatinine) = 7.094238-0.043104 × CKD-EPI creatinine - 0.057537 × haematocrit. CKD equation (cystatin) = 8.375074-0.117218 × CKD-EPI cystatin. CKI equation (creatinine) = 0.428389-0.043214 × CKD-EPI creatinine +0.183051 × Child-Pugh score + 0.050162 × age (in years). CKI equation (cystatin) = 9.169579-0.139319 × CKD-EPI cystatin. CONCLUSION: Simple and reliable equations have been obtained for screening chronic kidney disease and chronic kidney insufficiency in cirrhotic patients.

Prevalencia de dolor y manejo en la central de emergencias / Prevalence of pain and management in emergency department

OBJETIVOS: Estimar prevalencia de dolor como motivo de consulta en la Central de Emergencias de Adultos (CEA). MATERIALES Y MÉTODOS: Corte transversal que incluyó consultas en la CEA del Hospital Italiano de Buenos Aires entre 2016-2017. Se consideraron casos aquellos con dolor según subset terminológico en el motivo principal de la epicrisis. Se recolectaron variables desde bases de datos secundarias de alta calidad y a través de revisión manual. RESULTADOS: La prevalencia fue 52%(196/373) con IC95% 47-57%. Los pacientes eran 68% de sexo femenino, con edad media de 51 años, y la mayoría se asignaron a áreas de baja complejidad para su atención. Casi el 20% (38/196) recibió algún tratamiento analgésico siendo la vía de administración más frecuente intravenosa (52%). El registro inicial de dolor ocurrió sólo un 12% por enfermería y en 83% por médicos. CONCLUSIÓN: Se requiere mejorar el registro para garantizar valoración y manejo efectivo de dolor (AU)

OBJETIVE: To estimate pain prevalence as a reason for consultation at Emergency Department (ED). METHODS: Cross sectional with consultations admitted to ED of Hospital Italiano de Buenos Aires between 2016-2017. Cases were defines as those with a terminological subset according to the main reason. Variables were collected from secondary databases of high quality and manual review. RESULTS: Prevalence was 52% (196/373) with 95%CI 47-57. Patients were 68% female, with a mean age of 51 years, and most were assigned to areas of low complexity for their attention. Almost 20% (38/196) received some analgesic treatment, being intravenous (52%) the most frequent route of administration. Initial recording of pain occurred only 12% by nurses and 83% by physicians. CONCLUSION: Registration is required to improve for ensure effective assessment and management of pain (AU)

Adecuaciones curriculares interdisciplinarias en Filosofía y Sociedad en Licenciatura en Psicología en ciencias médicas / Curricular adaptations to an interdisciplinary approach in the program of Philosophy and society in the career of Psychology in Medical Sciences

Se exponen los resultados de una investigación realizada en el campo del diseño curricular de la Licenciatura en Psicología en Ciencias Médicas. Se teoriza en torno a las relaciones interdisciplinarias, currículos integradores e integración de contenidos. Parte de las necesidades no cubiertas en el programa de Filosofía y Sociedad I y II para propiciar el enfoque interdisciplinario en la enseñanza-aprendizaje. De acuerdo con las posibilidades que ofrece el mencionado programa, se proponen adecuaciones curriculares, basadas en la organización del contenido en temáticas interdisciplinarias, y se acompaña de las orientaciones metodológicas. La propuesta se valora como positiva por criterio de especialistas, dada la actualidad de la temática, su novedad, su carácter flexible y correspondencia con el contexto en que se forman los futuros profesionales, por lo que constituye un valioso aporte en la consideración del enfoque interdisciplinario desde el diseño de los programas.(AU)