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Frailty as Tested by Gait Speed Is a Risk Factor for Liver Transplant Respiratory Complications.

通过步态速度测试的虚弱是肝移植呼吸并发症的危险因素。

  • 影响因子:4.03
  • DOI:10.14309/ajg.0000000000000609
  • 作者列表:"Salim TI","Nestlerode LC","Lucatorto EL","Wasserman TL","Din HA","Landsittel DP","Tevar AD","Johnson JT","Duarte-Rojo A","Dunn MA
  • 发表时间:2020-03-31
Abstract

OBJECTIVES:Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS:For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS:Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION:Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.

摘要

目的: 虚弱和肌肉减少症是肝移植不良预后和死亡率的已知危险因素。我们假设虚弱或肌肉减少症可以识别常见严重移植相关不良呼吸事件的风险。 方法: 对于 107 例 (74 例男性,33 例女性) 移植超过 1 年的患者,我们用步态速度、椅子站立和 Karnofsky 性能量表 (KPS) 测量虚弱程度 l3 计算机断层扫描显示骨骼肌指数与肌少症。我们记录了压力测试的心脏双重产物,作为心脏做功能力的指标。结果包括插管天数、误吸、临床肺炎、再插管/气管切开、出院天数和存活率。我们使用未经调整的回归和多变量分析对结局进行建模,这些分析控制了 (i) 年龄、性别和终末期肝病的任一模型-Na (MELDNa) 或 Child-Turcotte-Pugh 评分,(ii) 肝细胞癌状态,(iii) 慢性阻塞性肺疾病和吸烟史。对活体肝移植供体和死亡供体肝移植受者进行亚组分析。 结果: 步态速度与误吸和肺部感染呈负相关,在未经校正的和 MELDNa 校正的模型中 (误吸的校正比值比为 0.10 [95% 置信区间 [CI] 0.02-0.67] 和肺部感染的校正比值比为 0.12 [95% CI 0.02-0.75])。步态速度 (系数-1.47,95% CI -2.39 至-0.56) 和 KPS (系数-3.17,95% CI -5.02 至-1.32) 的未调整和 MELDNa 调整模型与较短的插管时间显著相关。没有检测与住院时间或需要再次插管或气管切开相关。 讨论: 缓慢的步态速度,一般虚弱的指标,表明移植后呼吸并发症的显著风险。阻止或逆转虚弱的干预值得探索作为改善移植呼吸结局的潜在可改变的危险因素。

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作者列表:["Moon AM","Jiang Y","Rogal SS","Tapper EB","Lieber SR","Barritt AS 4th"]

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翻译标题与摘要 下载文献
影响因子:3.87
发表时间:2020-02-01
DOI:10.1111/liv.14321
作者列表:["Chen VL","Chen Y","Du X","Handelman SK","Speliotes EK"]

METHODS:BACKGROUND AND AIMS:Cirrhosis is characterized by extensive fibrosis of the liver and is a major cause of liver-related mortality. Cirrhosis is partially heritable but genetic contributions to cirrhosis have not been systemically explored. Here, we carry out association analyses with cirrhosis in two large biobanks and determine the effects of cirrhosis associated variants on multiple human disease/traits. METHODS:We carried out a genome-wide association analysis of cirrhosis as a diagnosis in UK BioBank (UKBB; 1088 cases vs. 407 873 controls) and then tested top-associating loci for replication with cirrhosis in a hospital-based cohort from the Michigan Genomics Initiative (MGI; 875 cases of cirrhosis vs. 30 346 controls). For replicating variants or variants previously associated with cirrhosis that also affected cirrhosis in UKBB or MGI, we determined single nucleotide polymorphism effects on all other diagnoses in UKBB (PheWAS), common metabolic traits/diseases and serum/plasma metabolites. RESULTS:Unbiased genome-wide association study identified variants in/near PNPLA3 and HFE, and candidate variant analysis identified variants in/near TM6SF2, MBOAT7, SERPINA1, HSD17B13, STAT4 and IFNL4 that reproducibly affected cirrhosis. Most affected liver enzyme concentrations and/or aspartate transaminase-to-platelet ratio index. PheWAS, metabolic trait and serum/plasma metabolite association analyses revealed effects of these variants on lipid, inflammatory and other processes including new effects on many human diseases and traits. CONCLUSIONS:We identified eight loci that reproducibly associate with population-based cirrhosis and define their diverse effects on human diseases and traits.

翻译标题与摘要 下载文献
影响因子:2.57
发表时间:2020-02-01
DOI:10.1111/eci.13198
作者列表:["Li H","Wieser A","Zhang J","Liss I","Markwardt D","Hornung R","Neumann-Cip AC","Mayerle J","Gerbes A","Steib CJ"]

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