Sarcopenia and Frailty in the Prognosis of Patients on the Liver Transplant Waiting List

Ebadi, Maryam; Montaño-Loza, Aldo J.

doi:10.1002/lt.25386

Cited by 17 publications

(15 citation statements)

References 10 publications

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“…25 Similar to sarcopenia, frailty is common in patients with cirrhosis, particularly in those with decompensated liver disease; however, the prevalence of frailty is somewhat more difficult to report precisely since there are several assessment tools, cut-offs, and sometimes being reported as a continuous index. 3 In outpatient setting, while the prevalence of frailty was up to 43% (defined by Fried Frailty Index ≥ 3) among 542 patients with cirrhosis referred for LT (52% had ascites). 26 Obesity is frequently observed in cirrhosis (20%-40%), regardless of the aetiology of liver disease, and patients with cirrhosis may develop simultaneous loss of skeletal muscle and gain of adipose tissue, culminating in the condition of sarcopenic obesity.…”

Section: Pre Valen Ce Of Maln Utriti On/ Sarcopenia and Fr Ailt Y Imentioning

confidence: 98%

“…Similar to sarcopenia, frailty is common in patients with cirrhosis, particularly in those with decompensated liver disease; however, the prevalence of frailty is somewhat more difficult to report precisely since there are several assessment tools, cut‐offs, and sometimes being reported as a continuous index . In outpatient setting, the prevalence of frailty was 18% (defined by CFS > 4) among 300 patients with cirrhosis from various aetiologies (28% had ascites) .…”

Section: Prevalence Of Malnutrition/sarcopenia and Frailty In Cirrhosismentioning

confidence: 99%

“…These three conditions are increasingly common among patients with cirrhosis, particularly in those with decompensated liver disease, and in fact relatively overlap (but not identical), and all contributing to physical deconditioning and increased mortality . The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve . It has clearly been shown that in those with cirrhosis and with malnutrition/sarcopenia/frailty there is reduced quality of life and survival, increased rates of cirrhotic complications and infections and have worse outcomes following surgery and liver transplantation (LT) .…”

Section: Introductionmentioning

confidence: 99%

“…1 The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve. 3 It has clearly been shown that in those with cirrhosis and with malnutrition/sarcopenia/frailty there is reduced quality of life and survival, increased rates of cirrhotic complications and infections and have worse outcomes following surgery and liver transplantation (LT). 1,[3][4][5] The pathogenesis of these conditions is complex and multifactorial and is more than just simple reduction of protein and calorie intake.…”

Section: Introductionmentioning

confidence: 99%

“…3 It has clearly been shown that in those with cirrhosis and with malnutrition/sarcopenia/frailty there is reduced quality of life and survival, increased rates of cirrhotic complications and infections and have worse outcomes following surgery and liver transplantation (LT). 1,[3][4][5] The pathogenesis of these conditions is complex and multifactorial and is more than just simple reduction of protein and calorie intake. 5 Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways.…”

Section: Introductionmentioning

confidence: 99%

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Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

146

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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Section: Pre Valen Ce Of Maln Utriti On/ Sarcopenia and Fr Ailt Y Imentioning

confidence: 98%

Section: Prevalence Of Malnutrition/sarcopenia and Frailty In Cirrhosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

146

131

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Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

et al. 2022

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Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio[OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR:1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007).The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.

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Effects of l‐carnitine on frailty status in patients with liver cirrhosis: A randomized‐controlled trial

Motazedian,

Ashari,

Dehdari Ebrahimi

et al. 2024

Health Science Reports

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Background and AimsFrailty is a common complication in patients with liver cirrhosis, which is linked with augmented rates of morbidity and mortality. In this regard, timely nutritional assessment and intervention have gained scientific attention. L‐carnitine may be a promising candidate with its potential to enhance energy metabolism, reduce inflammation, and act as an antioxidant. Therefore, we aimed to assess the impact of l‐carnitine supplementation on frailty status and liver function in adults with liver cirrhosis.MethodsThis double‐blinded, randomized, controlled clinical trial study enrolled 77 patients with liver cirrhosis. Patients were randomly allocated into two groups: the control group (n = 42) and the l‐carnitine group (n = 35). The l‐carnitine group received 500 mg of l‐carnitine orally three times a day for 8 weeks, while the control group did not receive any intervention.ResultsL‐carnitine administration resulted in a significant decrease in alanine transaminase levels (p: 0.043) and partial thromboplastin time (p: 0.036). Furthermore, compared to the control group, l‐carnitine treatment led to improvements in prothrombin time (p: 0.008) and international normalized ratio (p: 0.024). However, no significant improvement in the Liver Frailty Index, Freid Frailty Index, and Karnofsky Performance Status Scale (p > 0.05) was observed in the carnitine group after the 8‐week intervention period.ConclusionIn conclusion, the administration of l‐carnitine exhibited hepatoprotective properties and was correlated with lowered alanine transaminase levels with improvement in coagulation status in liver cirrhosis patients. Nevertheless, our study indicated that the short‐term use of l‐carnitine might not significantly improve frailty in these patients.

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Sarcopenia and Frailty in the Prognosis of Patients on the Liver Transplant Waiting List

Cited by 17 publications

References 10 publications

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

Effects of l‐carnitine on frailty status in patients with liver cirrhosis: A randomized‐controlled trial

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