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1.
Dig Liver Dis ; 51(11): 1508-1512, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31601536

RESUMEN

BACKGROUND: Since the use of the Model for End-Stage Liver Disease (MELD) score for establishing the prognosis of cirrhotic patients has been introduced, questions have been raised whether complications of liver cirrhosis would provide additional information. Myosteatosis, sarcopenia and hepatic encephalopathy (HE) are frequent in cirrhosis and may affect prognosis. Aim of the study was analyzing if these factors are independently related to survival and may improve the accuracy of MELD. METHODS: 249 cirrhotics that underwent abdominal CT-scan were enrolled. For each patient, information about previous episodes of HE and muscle alterations were obtained. Patients were followed until transplantation or death. RESULTS: History of HE, MELD, sarcopenia and myosteatosis were independently associated with mortality. The MELD-Sarco-Myo-HE score added accuracy to the MELD score alone for 6- and 3-months mortality. By removing HE, as the only not quantifiable parameter of the model, no relevant decrease in accuracy for 6- and 3-months mortality detection was observed. CONCLUSIONS: The accuracy of MELD in predicting 3- and 6-months mortality may be improved by considering the muscle alterations. A model considering the above parameters may classify more accurately over 30% of the patients.


Asunto(s)
Enfermedad Hepática en Estado Terminal/epidemiología , Encefalopatía Hepática/epidemiología , Músculo Esquelético/patología , Sarcopenia/epidemiología , Anciano , Enfermedad Hepática en Estado Terminal/etiología , Femenino , Encefalopatía Hepática/etiología , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Sarcopenia/etiología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
2.
Clin Transl Gastroenterol ; 10(4): e00025, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30939488

RESUMEN

INTRODUCTION: Muscle mass has been shown to be a prognostic marker in patients with liver cirrhosis. Transversal psoas muscle thickness normalized by height (TPMT/height) obtained by routine computed tomography is a simple surrogate parameter for sarcopenia. TPMT/height, however, is not sex specific, which might play a role in risk stratification. Its association with acute-on-chronic liver failure (ACLF) has not been established yet. ACLF is associated with systemic inflammatory dysregulation. This study aimed at evaluating the role of sarcopenia in ACLF development of patients with decompensated cirrhosis receiving transjugular intrahepatic portosystemic shunt (TIPS) using sex-specific TPMT/height. METHODS: One hundred eighty-six patients from the prospective Non-invasive Evaluation Program for TIPS and Follow Up Network cohort (observational, real-world TIPS cohort with structured follow-up) were analyzed. TPMT/height was measured from routine computed tomography. The sex-specific cutoff was determined to classify patients as sarcopenic and nonsarcopenic for 1-year mortality after TIPS. Clinical outcome was compared. Primary end points were ACLF and 1-year mortality after TIPS. Secondary end points were development of decompensations (hepatic encephalopathy and ascites) after TIPS. RESULTS: The sex-specific cutoff increases the diagnostic accuracy with regard to primary and secondary end points compared with the unisex cutoff. Sex-specific sarcopenia classification is an independent predictor of 1-year mortality and ACLF development in patients with cirrhosis receiving TIPS. Patients in the sarcopenia group showed significantly higher rates of mortality, ascites, overt hepatic encephalopathy, and ACLF after TIPS compared with the nonsarcopenia group. The Chronic Liver Failure Consortium Acute Decompensation score as a marker of systemic inflammation was significantly higher in sarcopenic patients. CONCLUSIONS: This study demonstrates for the first time that sarcopenia is related to ACLF development and systemic inflammation. The prognostic value of TPMT/height can be improved by using sex-specific cutoffs. ClinicalTrials.gov identifier: NCT03584204.


Asunto(s)
Insuficiencia Hepática Crónica Agudizada/epidemiología , Cirrosis Hepática/complicaciones , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Sarcopenia/epidemiología , Insuficiencia Hepática Crónica Agudizada/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estatura , Femenino , Estudios de Seguimiento , Humanos , Cirrosis Hepática/mortalidad , Cirrosis Hepática/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/fisiopatología , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Sarcopenia/diagnóstico , Sarcopenia/etiología , Sarcopenia/fisiopatología , Factores Sexuales , Tomografía Computarizada por Rayos X , Adulto Joven
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