Sarcopenia in Cirrhosis: Fallout on Liver Transplantation
| Autor: | Viniyendra Pamecha, Varsha Shasthry, Vaibhaw Kumar, Guresh Kumar, Jaya Benjamin, Piyush Kumar Sinha, Kishore Gurumoorthy Subramanya Bharathy |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Cirrhosis Hepatology business.industry medicine.medical_treatment Acute kidney injury Liver transplantation medicine.disease Chronic liver disease Gastroenterology Intensive care unit law.invention Sepsis 03 medical and health sciences 0302 clinical medicine law 030220 oncology & carcinogenesis Sarcopenia Internal medicine medicine 030211 gastroenterology & hepatology Original Article business Dialysis |
| Zdroj: | J Clin Exp Hepatol |
| ISSN: | 0973-6883 |
| Popis: | BACKGROUND: Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard. AIM: To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT. METHODS: Pre LT, single-slice routine computed tomography images at L3 vertebra of 115 LT recipients were analyzed, to obtain cross-sectional area of six skeletal muscles normalized for height in m(2) – skeletal muscle index (SMI; cm(2)/m(2)). SMI< 52.4 in males and 3:≤3 = 56.5%:43.5%]. Sarcopenics vs. Nonsarcopenics; early postoperative complications: [sepsis, 49(89%) vs. 33(55%), P = 0.001; neurologic complications, 16(29.6%) vs. 5(8.8%), P = 0.040; Clavien-Dindo Classification ≥3–24 (43.6%):15 (25.4%),P = 0.041; ancillary parameters (days), duration of ventilation [median (range)] 1.5(1–3) vs. 1 (1–2), P = 0.021; intensive care unit (ICU) stay 12 (8–16) vs. 10 (8–12), P = 0.024; time to ambulation 9 (7–11) vs. 6 (5–7), P = 0.001; drain removal 18.7 ± 7.3 vs. 14.4 ± 6.2, P = 0.001; need for tracheostomy 5 (9%) vs. 0 (%), P = 0.017; preoperative prevalence of acute kidney injury, comorbidities and requirement for dialysis, intraoperative blood loss & inotropic support were significantly higher in sarcopenics. Ninety-day mortality was comparable between sarcopenics 5 (9.09%) and nonsarcopenics 4 (6.6%) P = 0.63. SMI (OR: 0.83; 95% CI: 0.71–0.97, P = 0.016; Acute on chronic liver failure (ACLF) presentation 12.5 (1.65–95.2), P = 0.015 and intraoperative blood loss 3.74 (0.96–14.6), P = 0.046 were predictors of 90-day mortality. CONCLUSION: Almost 50% of LT recipients had sarcopenia, who had a higher incidence of postoperative sepsis, neurological complications, longer ICU stay and ventilatory support. Low SMI, ACLF presentation, and intraoperative blood loss were the independent predictors of early mortality. |
| Databáze: | OpenAIRE |
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