Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático

Abstract

Introduction: Chronic liver disease results in large functional impact, causing loss of muscle mass and function with consequent reduction of functional capacity. Objective: To evaluate and compare the respiratory muscle strength and functional capacity of candidates for liver transplantation who are under Class B or C according to Child Pugh Score and to correlate these variables within each group. Methods -Cross-sectional study with a convenience sample of 35 patients divided into two groups based on the score obtained in the Child Pugh Score B (19 patients) and Child Pugh Score C (16 patients). All subjects were evaluated in a single moment, and the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the distance walked during the 6-minute walk test (6MWT) were measured. Results: Individuals classified with Child Pugh Score B showed higher values in the MIP (-86.05 vs. 23.89 -57.94 14.14), p = 0.001, in MEP (84.16 vs. 28.26 72.00 16 1994), p = 0.142, and the distance walked in 6MWT (473.63 vs 376.13 39.00 55.276), p = 0.001. We also found a positive correlation between the values of MIP and distance walked during 6MWT in group B of the Child Pugh Score, r = 0.64 and p = 0.003. Conclusion: The progress of liver disease contributes to the onset of several complications, which together appear to contribute to the reduction of functional capacity of individuals. In our study this was evidenced by the worse performance of Child Pugh score C group. This may suggest that the wait for liver transplantation (LTx) can worsen the functional capacity of these individuals.

Respiratory muscle strength and exercise capacity of children and adolescents with chronic liver diseases Exercise capacity in liver disease

“…In the present study, 22.5% of the individuals had liver cirrhosis and reduced values of the MIP, MEP, and distance traveled on the 6MWT. Pereira et al (2011) found that the respiratory muscle strength and exercise capacity of adults with hepatic cirrhosis were proportional to the severity of the disease and were lower in patients with more advanced cirrhosis than in those with less advanced disease. Patients with cirrhosis have hepatic insufficiency, which is commonly accompanied by several findings, such as decreased muscle mass (MANTANO-LOZA et al, 2012), changes in growth anddevelopment, andmalnutrition (FAINTUCH, 2000), besides lower synthesis of albumin and others proteins.…”

“…Many patients with chronic liver disease develop liver cirrhosis (PEREIRA et al, 2011), including cirrhosis-consequent disorders such as liver atresia, active chronic hepatitis, alfa 1 antitrypisin deficiency, Wilson's disease (DE BRITO et al, 2005;ROBERTS;SCHILSKY, 2008) and type IX glycogen storage disease (BURDA;HOCHULI, 2015). In the present study, 22.5% of the individuals had liver cirrhosis and reduced values of the MIP, MEP, and distance traveled on the 6MWT.…”

“…However, patients with chronic liver disease may have a reduction in this strength (PEREIRA et al, 2016). Changes in respiratory muscle strength measured by maximum respiratory pressures may be associated with reduced exercise capacity (CAR-VALHO et al, 2008) and worse clinical prognosis (PEREIRA et al, 2011;PEREIRA et al, 2016).…”

The Benefits of Neuromuscular Electrical Stimulation in the Muscular and Functional Capacity of Patients With Liver Cirrhosis: Protocol for a Randomized Clinical Trial

“…Considering that cirrhosis is a progressive disease, Pereira et al 33 state that the advancement of hepatic diseases tends to further reduce the functional capacity of those afflicted, because patients with a Child-Pugh score of C had worse performance on the 6MWT compared with patients with Child-Pugh scores of A and B. Recently, Pereira et al 34 demonstrated in a survivability analysis that individuals with cirrhosis who walk a distance smaller than 410 m had a survivability rate of 55%.…”

Capacidade funcional de candidata ao transplante de fígado após fisioterapia: relato de caso

“…Pereira et al 6 pesquisaram 35 pacientes e mostraram que o progresso da doença hepática contribui para o aparecimento de várias complicações, que parecem favorecer a redução da capacidade funcional dos indivíduos. Esta pode ser medida por meio do teste de caminhada de seis minutos (TC6), um indicador da capacidade física global que tem o objetivo de avaliar pré e pós-intervenção médica e é um bom preditor de morbidade e mortalidade por doenças cardiorrespiratórias, bem como por complicações decorrentes de transplante de pulmão, coração e fígado.…”