肝硬化患者的中臂肌肉围度临界点：与营养不良有关的低肌肉质量可预测死亡率

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-04-23 DOI:10.1016/j.nut.2024.112471

Camila Saueressig PhD , Bruna Cherubini Alves PhD , Vivian Cristine Luft PhD , Lucilene Rezende Anastácio PhD , Bárbara Chaves Santos MSc , Lívia Garcia Ferreira PhD , Ana Luísa Ferreira Fonseca MSc , Rosângela Passos de Jesus PhD , Lucivalda Pereira Magalhães de Oliveira PhD , Ramona Souza da Silva Baqueiro Boulhosa PhD , André Castro Lyra PhD , Fernando Gomes Romeiro PhD , Dan Linetzky Waitzberg PhD , Giliane Belarmino PhD , Valesca Dall'Alba PhD

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引用次数: 0

摘要

目的肌肉损失是营养不良的表型标准之一，在肝硬化患者中非常普遍，并与不良预后有关。中臂肌围（MAMC）可估算骨骼肌质量，尤其有助于液体超负荷的情况。本研究旨在提出肝硬化患者的中臂肌肉围度临界点，并证明其与 1 年死亡率的关系。本研究对巴西五个参考中心的队列数据库进行了分析，其中包括年龄≥18 岁的住院和门诊肝硬化患者。考虑到灵敏度、特异性和尤登指数，我们根据主观全面评估确定了按性别分层的 MAMC 临界点，作为营养不良诊断的参考标准。结果我们纳入了 1075 名肝硬化患者，平均年龄为（54.8 ± 11.3）岁；70.4%（n = 757）为男性。大多数患者为酒精性肝硬化（47.1%，n = 506），被归类为Child-Pugh B（44.7%，n = 480）。MAMC 中度和重度耗竭的临界点分别为：女性≤21.5 厘米和≤24.2 厘米；男性≤20.9 厘米和≤22.9 厘米。根据这些截断点，分别有13.8%（n = 148）和35.1%（n = 377）的患者存在中度或重度MAMC耗竭。1年死亡率为17.3%（n = 186）。在对性别、年龄、MELD-Na 和 Child-Pugh 评分进行调整后的多变量分析中，MAMC 严重耗竭是增加 1 年死亡率的独立风险因素（HR：1.71，95% CI：1.24-2.35，P < 0.001）。结论根据新截断点划分的低 MAMC 可预测肝硬化患者的死亡风险，并可用于临床实践。

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Mid-arm muscle circumference cutoff points in patients with cirrhosis: Low muscle mass related to malnutrition predicts mortality

Objectives

Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality.

Methods

This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality.

Results

We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24–2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85–0.94, P < 0.001).