Year 2024 / Volume 116 / Number 5
Original
Are sarcopenia, frailty and malnutrition prognostic markers of liver disease decompensation in the ambulatory setting? – A prospective cohort study

250-257

DOI: 10.17235/reed.2023.9907/2023

João Correia, Maria Manuela Estevinho, Pedro Mesquita, Luís Correia Gomes, Ana Paula Silva, Sónia Fernandes, Jaime Rodrigues, Edgar Afecto, Teresa Freitas,

Abstract
Background: sarcopenia, frailty and malnutrition are associated with adverse outcomes in liver cirrhosis. Studies assessing the prognostic value of these conditions in ambulatory patients with cirrhosis are scarce. Methods: a prospective cohort study was performed, with consecutive inclusion of all patients with cirrhosis observed in the Hepatology outpatient clinic of a Portuguese tertiary center. At study enrolment, evaluation of muscle mass (ultrasound quadriceps femoris thickness), muscle strength (handgrip dynamometry) and nutritional status (Patient-Generated Subjective Global Assessment Short Form) were performed. Follow-up ended upon the occurrence of a composite endpoint, comprising of liver decompensation events and liver-related death, or last medical appointment/non-liver related death before the end of the study. The prognostic value of anthropometrical parameters and nutritional status in the composite endpoint was assessed using a multivariate Cox regression analysis, adjusted for several confounders. Results: ninety patients were enrolled (80 % male), with a mean age of 63.5 ± 10.5 years. The median follow-up was 30 (interquartile range 38) weeks, during which, 12 patients reached the composite endpoint. These patients presented a lower mean handgrip strength (23.1 ± 6.41 vs 30.3 ± 10.4 kg, p = 0.04) compared to patients who did not reach the composite endpoint. However, Cox regression multivariate analysis did not find any independent predictors of the composite endpoint, apart from previous decompensation episodes. Conclusion: in this study, muscle strength was lower in the group of patients with cirrhosis who presented a liver-related event. Handgrip strength might be a promising tool in the ambulatory setting to identify patients at risk of liver decompensation and liver-related death in the short term.
Lay Summary
This study investigated the association between sarcopenia, frailty, and malnutrition and adverse outcomes in liver cirrhosis patients. A prospective cohort study was performed with 90 cirrhosis patients, assessing muscle mass, strength, and nutritional status. Over a median follow-up of 30 weeks, 12 patients reached a composite endpoint of liver decompensation events or liver-related death. Despite lower handgrip strength in patients reaching the endpoint, multivariate analysis revealed no independent predictors, except for a history of previous decompensation episodes. The study suggests that handgrip strength may be a promising tool to identify short-term risks in cirrhosis patients.
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References
1. Puri P, Dhiman RK, Taneja S, et al. Nutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver. J Clin Exp Hepatol. 2021;11(1):97-143.
2. Lai JC, Tandon P, Bernal W, et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(3):1611-1644.
3. Tantai X, Liu Y, Yeo YH, et al. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022;76(3):588-599.
4. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601]. Age Ageing. 2019;48(1):16-31.
5. Mandill J, Hilwah M, Sinclair L, et al. A272 UTILIZING BEDSIDE ULTRASOUND TO ASSESS MUSCLE MASS IN CIRRHOTIC PATIENTS ASSESSED FOR LIVER TRANSPLANTATION. J Can Assoc Gastroenterol. 2019;2(Suppl 2):537-538.
6. Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology. 2017;65(3):1044-57.
7. Kobayashi K, Maruyama H, Kiyono S, et al. Application of transcutaneous ultrasonography for the diagnosis of muscle mass loss in patients with liver cirrhosis. J Gastroenterol. 2018;53(5):652-659.
8. Shpoliansky M, Chavhan GB, Zhou A, et al. A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease. Hepatol Commun. 2023;7(8):e0211.
9. Hari A. Muscular abnormalities in liver cirrhosis. World J Gastroenterol. 2021;27(29):4862-4878.
10. Xu CQ, Yao F, Mohamad Y, et al. Evaluating the Associations Between the Liver Frailty Index and Karnofsky Performance Status With Waitlist Mortality. Transplant Direct. 2021;7(2):e651. Published 2021 Jan 7.
11. Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005;21(2):113-117.
12. Buchard B, Boirie Y, Cassagnes L, et al Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?. Nutrients. 2020;12(1):186.
13. Lee SH, Gong HS. Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis. J Bone Metab. 2020;27(2):85-96.
14. Zhang Q, Li XR, Zhang X, et al. PG-SGA SF in nutrition assessment and survival prediction for elderly patients with cancer. BMC Geriatr. 2021;21(1):687.
15. Angeli P, Garcia-Tsao G, Nadim MK et al. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. Journal of hepatology 2019; 71: 811-822. doi:10.1016/j.jhep.2019.07.002
16. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048.
17. Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019;79(Suppl 1):5-9.
18. Rosner B. Fundamentals of biostatistics. Seventh edition. Boston : Brooks/Cole, Cengage Learning, 2011.
19. Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-173.e1.
20. Daphnee DK, John S, Vaidya A et al. Hand grip strength: A reliable, reproducible, cost-effective tool to assess the nutritional status and outcomes of cirrhotics awaiting liver transplant. Clinical Nutrition ESPEN 2017; 19: 49-53.
21. Hanai T, Shiraki M, Imai K, et al. Reduced handgrip strength is predictive of poor survival among patients with liver cirrhosis: A sex-stratified analysis. Hepatol Res. 2019;49(12):1414-1426.
22. Hanai T, Shiraki M, Watanabe S, et al. Sarcopenia predicts minimal hepatic encephalopathy in patients with liver cirrhosis. Hepatol Res. 2017;47(13):1359-1367.
23. Dhariwal S, Roy A, Taneja S, et al. Assessment of Sarcopenia Using Muscle Ultrasound in Patients With Cirrhosis and Sarcopenic Obesity (AMUSE STUDY). J Clin Gastroenterol. 2023;57(8):841-847.
24. Tandon P, Low G, Mourtzakis M, et al. A Model to Identify Sarcopenia in Patients With Cirrhosis [published correction appears in Clin Gastroenterol Hepatol. 2022 Jun;20(6):1423]. Clin Gastroenterol Hepatol. 2016;14(10):1473-1480.e3.
25. Alfuraih AM, Tan AL, O'Connor P, Emery P, et al. The effect of ageing on shear wave elastography muscle stiffness in adults. Aging Clin Exp Res. 2019;31(12):1755-1763.
26. Becchetti C, Lange NF, Delgado MG, et al. 2D shear wave elastography of the rectus femoris muscle in patients with cirrhosis: Feasibility and clinical findings. A pilot study. Clin Res Hepatol Gastroenterol. 2023;47(3):102080.
27. Sharma P, Rauf A, Matin A, et al. Handgrip Strength as an Important Bed Side Tool to Assess Malnutrition in Patient with Liver Disease. J Clin Exp Hepatol. 2017;7(1):16-22.
28. Sinclair M, Chapman B, Hoermann R et al. Handgrip Strength Adds More Prognostic Value to the Model for End-Stage Liver Disease Score Than Imaging-Based Measures of Muscle Mass in Men With Cirrhosis. Liver Transpl. 2019;25(10):1480-1487.
29. Davuluri G, Giusto M, Chandel R, et al. Impaired Ribosomal Biogenesis by Noncanonical Degradation of β-Catenin during Hyperammonemia. Mol Cell Biol. 2019;39(16):e00451-18.
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Correia J, Estevinho M, Mesquita P, Gomes L, Silva A, Fernandes S, et all. Are sarcopenia, frailty and malnutrition prognostic markers of liver disease decompensation in the ambulatory setting? – A prospective cohort study . 9907/2023


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Publication history

Received: 17/08/2023

Accepted: 27/11/2023

Online First: 14/12/2023

Published: 09/05/2024

Article revision time: 81 days

Article Online First time: 119 days

Article editing time: 266 days


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