Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: Case report

Motamedi, Mohammad Ali Kalantar; Barzin, Maryam; Ebrahimi, Mohammadreza; Ebrahimi, Reza; Khalaj, Alireza

doi:10.1016/j.ijscr.2017.02.033

Cited by 45 publications

(25 citation statements)

References 18 publications

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“…Albumin on the other hand is significantly lower in the kwashiorkor than in the marasmic children which may be due to relative protein deficiency in the former, a similar finding was reported by studies of Reeds & Laditan; Malcolm [31,32]. Protein deficiency results in low albumin and marginal weight loss, the true weight loss often masked by fluid retention, [33,34,35]. Mid upper arm circumference and albumin differ significantly between the well-fed, marasmic and the kwashiorkor groups.…”

Section: Discussionsupporting

confidence: 79%

Albumin and Serum Vitamin A Status of Malnourished Children

Richard¹,

Ekong²

2018

EJCBS

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Malnutrition remains a major health problem in the third world countries, and is a key factor to the high death rate among children below five years old. This study aimed to determine serum vitamin A, mid-upper arm circumference (MUAC), and albumin levels of malnourished children and their well-fed counterparts. A total of one hundred (100) children comprising of fifty (50) malnourished children under the age of five years and fifty (50) well-fed age-matched children were recruited into this study. Mid upper arm circumference (MUAC) measurement was used to categorize the children into malnourished and the well-fed groups. The malnourished were further classified into kwashiorkor and marasmic cohorts. Serum vitamin A and albumin levels were determined by colorimetric methods. Data were analyzed using SPSS version 20.0 statistical package, differences between and variations among groups were determined by Student's t-test and ANOVA respectively while the association between variables by Pearson's correlation. Differences were considered statistically significant at p≤0.05. Serum vitamin A, MUAC and albumin levels of the well-fed group were significantly higher (p<0.05) than those of the malnourished. Comparing the well-fed, the kwashiorkor and the marasmic groups, the mean serum vitamin A, MUAC and albumin of the well-fed were significantly higher (p=0.001) than those of the kwashiorkor and marasmic groups. Mean albumin level of the kwashiorkor was significantly lower (p<0.05) than that of marasmic group. Mean MUAC of the kwashiorkor subjects was significantly higher (p<0.05) than that of the marasmic subjects. Serum vitamin A was not significantly different (p=0.724) between the kwashiorkor and the marasmic groups. In the marasmic subjects mean serum vitamin A correlates negatively with albumin (r= -0.517, p=0.011). In the kwashiorkor subjects, serum vitamin A correlates negatively with albumin (r=-0.080, p=0.690). In the well-fed children, serum vitamin A correlates positively with albumin (r=0.340, p=0.016). Conclusion: malnourished children with kwashiorkor and marasmus have lower albumin, serum vitamin A and MUAC compared with the well-fed children.

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Section: Discussionsupporting

confidence: 79%

Albumin and Serum Vitamin A Status of Malnourished Children

Richard¹,

Ekong²

2018

EJCBS

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“…(7,9) Over the last decade, several case series have described liver failure after BS. (10)(11)(12)(13) In most of the reports, liver failure occurred early postoperatively, presented with quick deterioration of liver function, and may have been associated with rapid weight loss and malnutrition. (12,14) However, the effect of BS on liver function and the nutrition consequences in patients with cirrhosis, regardless of etiology, years after BS are not completely clear.…”

Section: See Editorial On Page 203mentioning

confidence: 99%

“…The demographics and clinical characteristics of all the patients are shown in Table 1. By design, median (IQR) age (54 [46-61] years versus 54 [47-62] years) and MELD score (12 [8-20] versus 13 [9][10][11][12][13][14][15][16][17][18]) at evaluation were similar between the BS and concurrent cohorts. Patients in the BS cohort tended to be female (83.3% versus 44.2%; P < 0.01).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…The 1-and 3-year survival rates for BS versus the concurrent cohort was 85% (95% CI, 71%-100%) and 84% (95% CI, 74%-96%) versus 85% (95% CI, 71%-100%) and 82% (95% CI, 72%-94%; P = 0.57), respectively. The length of stay for the initial hospitalization was similar in the BS group (median [IQR]; 14 [8][9][10][11][12][13][14][15][16][17][18][19][20][21] days versus 9 [6-17] days; P = 0.13). The number of patients with at least 1 readmission (52% versus 52%) was similar (P = 1.0).…”

Section: Role Of Sexmentioning

confidence: 99%

“…The short‐term and longterm surgical complications of BS are well documented, including infection and nutrient deficiencies . Over the last decade, several case series have described liver failure after BS . In most of the reports, liver failure occurred early postoperatively, presented with quick deterioration of liver function, and may have been associated with rapid weight loss and malnutrition .…”

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confidence: 99%

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Impact of Prior Bariatric Surgery on Perioperative Liver Transplant Outcomes

Idriss

Hasse

et al. 2019

Liver Transpl

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Bariatric surgery (BS) is effective in treating morbid obesity, but the impact of prior BS on candidacy for liver transplantation (LT) is unclear. We examined 78 patients with cirrhosis with prior BS compared with a concurrent cohort of 156 patients matched by age, Model for End‐Stage Liver Disease score, and underlying liver disease. We compared rates of transplant denial after evaluation, delisting on the waiting list, and survival after LT. The median time from BS to LT evaluation was 7 years. Roux‐en‐Y gastric bypass was the most common BS procedure performed (63% of cohort). Nonalcoholic fatty liver disease was the leading etiology for liver cirrhosis (47%). Delisting/death on the waiting list was higher among patients with BS (33.3% versus 10.1%; P = 0.002), and the transplantation rate was lower (48.9% versus 65.2%; P = 0.03). Intention‐to‐treat (ITT) survival from listing to 1 year after LT was lower in the BS cohort versus concurrent cohort (1‐year survival, 84% versus 90%; P = 0.05). On adjusted analysis, a history of BS was associated with an increased risk of death on the waiting list (hazard ratio [HR], 5.7; 95% confidence interval [CI], 2.2‐15.1), but this impact was attenuated (HR, 4.9; 95% CI, 1.8‐13.4) by the presence of malnutrition. When limited to matched controls by sex, mortality attributed to BS was no longer significant for females (P = 0.37) but was significant for males (P = 0.046). Sarcopenia, as captured by skeletal muscle index, was calculated in a subset of patients (n = 49). The total skeletal surface area was lower in the BS group (127 [105‐141] cm2 versus 153 [131‐191] cm2; P = 0.005). Rates of sarcopenia were higher among patients delisted after listing (71.4% versus 16.7%; P = 0.04). In conclusion, a history of BS was associated with higher rates of delisting on the waiting list as well as lower survival from the time of listing on ITT analysis. Presence of malnutrition and sarcopenia among patients with BS may contribute to worse outcomes.

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