肝移植评估：一项队列研究：肌骨化病与虚弱和身体功能差有关

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-12-03 DOI:10.1111/ctr.70034

Heidi E. Johnston, Melita Andelkovic, Hannah L. Mayr, Yanyan Chen, Aaron P. Thrift, Graeme A. Macdonald, Ingrid J. Hickman

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引用次数: 0

摘要

肌骨化病是骨骼肌内脂肪浸润。肌骨增生症对肝移植患者身体功能和临床结果的影响尚不清楚。我们探讨了肌骨化病与肌肉减少症、虚弱、身体功能以及肝移植前后早期预后之间的关系。方法对237例LT患者（2018年3月至2022年9月）进行CT评估。卡方/ fisher精确检验和多变量回归比较了骨骼肌病和肌肉减少症、虚弱（肝脏虚弱指数）、身体功能（短体能电池，SPPB）；以及与肝移植前非计划住院、肝移植后手术并发症（Clavien-Dindo分级≥3）和肝移植住院时间（LOS）的关联。Kaplan-Meier和cox比例风险模型探讨了肌骨化症与肝移植和非计划入院时间的关系。Fine-Gray模型评估了接受lt的竞争风险。结果74例（31%）患者存在肌骨化病。肌骨增生症患者体弱的可能性是前者的2.5倍（95%可信区间[CI] 1.1-5.7, p = 0.03），是后者的3.0倍(95% CI 1.6-5.6, p <；0.001)比无骨骼肌病者更容易出现身体功能不良（SPPB≤9/12）。有肌骨增生症的患者比没有肌骨增生症的患者更有可能在肝移植前发生计划外住院（51%对36%，p = 0.03），但在调整年龄、性别、终末期肝病模型（MELD）和肝细胞癌的存在后，这一差异没有统计学意义。肌肥大症对接受肝移植（p = 0.39）、肝移植后并发症（p = 0.93）或重症监护病房（ICU）（p = 0.66）或住院（p = 0.34）的LOS的可能性没有影响。结论：肌骨化病在肝移植患者中普遍存在，并与身体功能受损有关。在实践中使用现有的ct来评估肌骨增生症可能有助于识别身体受损的患者。

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Myosteatosis Is Associated With Frailty and Poor Physical Function in Patients Undergoing Liver Transplant Evaluation: A Cohort Study

Introduction

Myosteatosis is fat infiltration within skeletal muscle. The impact of myosteatosis on physical function and clinical outcomes in patients referred for liver transplantation (LT) is unclear. We explored associations between myosteatosis and sarcopenia, frailty, physical function, and pre- and early post-LT outcomes.

Methods

Myosteatosis was assessed by computed tomography (CT) in 237 patients referred for LT (March 2018 to September 2022). Chi-square/Fishers exact tests and multivariable regression compared myosteatosis and sarcopenia, frailty (liver frailty index), physical function (short physical performance battery, SPPB); and associations with pre-LT unplanned hospitalizations, post-LT surgical complications (Clavien–Dindo grade ≥ 3), and LT admission length of stay (LOS). Kaplan–Meier and Cox-proportional hazards models explored myosteatosis and time to LT and unplanned admission. Fine–Gray model evaluated the competing risks of receiving an LT.

Results

Myosteatosis was present in 74 (31%) patients. Patients with myosteatosis were 2.5 times (95% confidence interval [CI] 1.1–5.7, p = 0.03) more likely to be frail, and 3.0 times (95% CI 1.6–5.6, p < 0.001) more likely to have a poor physical function (SPPB ≤ 9/12) than those without myosteatosis. Patients with myosteatosis versus those without were more likely to have a pre-LT unplanned hospitalization (51% vs. 36%, p = 0.03), but significance was lost after adjusting for age, sex, Model for End-stage Liver Disease (MELD), and the presence of hepatocellular carcinoma. Myosteatosis did not impact the likelihood of receiving an LT (p = 0.39), post-LT complications (p = 0.93), or LOS in intensive care unit (ICU) (p = 0.66) or hospital (p = 0.34).

Conclusions

Myosteatosis is prevalent in patients referred for LT and is associated with impaired physical function. Using existing CTs to assess myosteatosis in practice may help identify physically compromised patients.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.