scholarly journals Subjective Global Assessment and Handgrip Strength as Predictive Factors in Patients with Liver Cirrhosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Maria Ciocîrlan ◽  
Andreea Ruxandra Cazan ◽  
Mihaela Barbu ◽  
Mircea Mănuc ◽  
Mircea Diculescu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Global Assessment ◽  
Handgrip Strength ◽  
Assessment Tools ◽  
Subjective Global Assessment ◽  
Term Survival ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Short Term Survival

Background and Aims. Malnutrition is common in patients with chronic liver disease. We aimed to evaluate malnutrition assessment tools in predicting severity and survival of patients with liver cirrhosis. Material and Methods. We examined patients with liver cirrhosis. Nutritional evaluation was performed on admission, using subjective global assessment (SGA), handgrip strength (HGS), and anthropometry. Patients were followed up for 6 months. Results. We included 100 patients, 72 men, with mean age of 59.2 years. According to disease severity, patients were 23% Child-Pugh A, 46% Child-Pugh B, and 31% Child-Pugh C. SGA and HGS significantly correlated with Child-Pugh, MELD, and MELD-Na scores on admission. At 6 months follow-up, 80.4% (78 of 97) of patients survived, while 3 patients were lost from observation. Survival was predicted by SGA (1 death in 32 patients SGA A, 8 deaths in 46 patients SGA B, and 9 deaths in 19 patients SGA C, p=0.001) and HGS (25.1 ± 8.5 in deceased versus 30.6 ± 10.9 in survivors, p=0.046). The mean BMI and MAMC values did not significantly differ between patients who survived or were deceased at 6 months. Conclusion. HGS and SGA may predict severity and short-term survival in cirrhotic patients.

scholarly journals Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2287 ◽  
Author(s):  
Lynette M. De Groot ◽  
Gahee Lee ◽  
Antoinette Ackerie ◽  
Barbara S. van der Meij
Keyword(s):  
Mortality Risk ◽  
Cancer Care ◽  
Global Assessment ◽  
Short Form ◽  
Handgrip Strength ◽  
Assessment Tools ◽  
Ambulatory Setting ◽  
Severe Malnutrition ◽  
Subjective Global Assessment ◽  
Predictive Values

Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.

scholarly journals MALNUTRITION IN LIVER CIRRHOSIS

2020 ◽  
Vol 8 (10) ◽  
pp. 445-453
Author(s):  
Akshay Rawat ◽  
◽  
Arti Devi ◽  
Keyword(s):  
Liver Disease ◽  
Global Assessment ◽  
Nutritional Assessment ◽  
Assessment Tools ◽  
Subjective Global Assessment ◽  
Common Complication ◽  
Nutrient Metabolism ◽  
Global Assessment Scale ◽  
Advanced Liver Disease ◽  
Cirrhotic Patients

Malnutrition is a common complication of liver disease and it adversely affects patient outcome. Aetiologic factors include hypermetabolism, malabsorption, altered nutrient metabolism and anorexia. Use of traditional nutritional assessment tools, such as anthropometry along with subjective global assessment scale and biometric measures, should be done to evaluate cirrhotic patients for malnutrition. Improvements in nutritional status can improve outcomes of patients with advanced liver disease.

Comparison of the Performance of Existing Nutritional Screening Tools against Subjective Global Assessment in Cirrhotic Patients

2021 ◽  
Vol 104 (8) ◽  
pp. 1301-1308
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Screening Tool ◽  
Risk Index ◽  
Assessment Tools ◽  
Screening Tools ◽  
Subjective Global Assessment ◽  
Nutritional Screening ◽  
Nutritional Risk Index ◽  
Cirrhotic Patients

Background: Malnutrition in cirrhosis has a significant negative impact on morbidity and mortality. There is no agreed gold standard of the screening tool. Study comparing the diagnostic properties of nutritional assessment tools in cirrhotic patients is limited. The Subjective Global Assessment (SGA) is one of the global assessment tools. It is used to assess nutritional status in different patient populations. Objective: To evaluate the diagnostic properties of different nutritional screening tools compared with SGA in cirrhotic patients. Materials and Methods: A cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center. All cirrhotic patients were enrolled. The nutritional status was evaluated by the SGA, the Royal Free Hospital Subjective Global Assessment (RFH-SGA), the Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST), the Malnutrition Universal Screening Tool (MUST), the Prognostic Nutritional Index (PNI-O), the Nutritional Risk Index (NRI), the Spanish Society of Parenteral, the Enteral Nutrition (SENPE), and the Controlling Nutritional Status (CONUT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate RFH-SGA, RFH-NPT, LDUST, MUST, PNI-O, NRI, SENPE, and CONUT compared with SGA. Results: Ninety-four cirrhotic patients were included. The mean age was 60.82 (SD 10.11) years. Patients with cirrhosis Child Turcotte Pugh (CTP) A, B, and C were 62, 21, and 11, respectively. Twenty-five patients (28.7%) were malnourished according to SGA, five with CTP A cirrhosis, twelve with CTP B cirrhosis, and ten with CTP C cirrhosis. The present study also showed that NRI had the highest sensitivity (100%) and LDUST had the highest specificity (94%). Conclusion: NRI is an effective tool with high sensitivity for identifying malnutrition in early stage of cirrhosis. Keywords: Nutritional screening; Cirrhosis; Subjective Global Assessment; SGA; Nutritional Risk Index; NRI

A systematic review of short metaphyseal loading cementless stems in hip arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 502-511 ◽  
Author(s):  
S. Lidder ◽  
D. J. Epstein ◽  
G. Scott
Keyword(s):  
Systematic Review ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Ethical Practice ◽  
Term Survival ◽  
The Mean ◽  
Review Reports ◽  
Femoral Implants ◽  
Hip Arthroplasties

Aims Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. Results A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. Conclusion Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502–511.

Is Subjective Global Assessment a Good Index of Nutrition in Peritoneal Dialysis Patients with Gastrointestinal Symptoms?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 78-82 ◽  
Author(s):  
Yanjun Li ◽  
Jie Dong ◽  
Li Zuo
Keyword(s):  
Peritoneal Dialysis ◽  
Lean Body Mass ◽  
Body Mass ◽  
Global Assessment ◽  
Handgrip Strength ◽  
Subjective Global Assessment ◽  
Gi Symptoms ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective We investigated whether patients with gastrointestinal (GI) symptoms were prone to be diagnosed as malnourished by subjective global assessment (SGA) by simultaneously evaluating SGA and other indices of nutrition in a cross-sectional survey of peritoneal dialysis (PD) patients. Patients and Method From June 2006 to June 2007, 214 PD patients were involved in the study. We recorded results of a GI symptoms questionnaire (GSQ) and SGA. Other indices of nutrition included dietary intake, chemistry examination, anthropometry, handgrip strength, and lean body mass measured by creatinine kinetics. Results Mean age of the 214 PD patients enrolled in the study was 60.22 ± 14.02 years, and mean dialysis duration was 60.22 ± 14.02 months. Of the 214 patients, 56 (27.16%) were diagnosed as malnourished by SGA. The mean GSQ scores were 9.37 ± 1.71 (range: 8 – 17). There were 90 patients with GSQ scores of 8 (group 1), 80 patients with scores of 9 or 10 (group 2), 44 patients with scores of 11 or more (group 3). The prevalence of malnutrition diagnosed by SGA was significantly different in the three groups: 15.56% in group 1, 27.5% in group 2, and 45.45% in group 3 ( p = 0.02). However, we observed no difference between the three groups in mid-arm circumference, skinfold thickness (biceps, triceps, subscapular, and suprailiac), daily protein and energy intake, handgrip strength, lean body mass, and serum albumin and prealbumin levels ( p > 0.05). Conclusions Our results showed that the reliability of SGA in PD patients with GI symptoms remains worth exploring. These patients are possibly diagnosed as malnourished by SGA, although many other indices of nutrition are not necessarily bad.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

scholarly journals Reconstruction of the Aortic Arch in Newborns and Infants Using an Extended End-to-End Anastomosis

2021 ◽  
pp. 63-68
Author(s):  
Iaroslav P. Truba ◽  
Ivan V. Dziuryi ◽  
Roman I. Sekelyk ◽  
Oleksandr S. Golovenko
Keyword(s):  
Hospital Mortality ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Mean ◽  
End To End ◽  
Aortic Arch Hypoplasia

The problem of the effectiveness of obstruction at the level of the aortic arch is still a matter of discus-sion in the modern literature. Traditionally, by excision of the coarctation part, in the presence of hypoplasia, the incision is extended to a narrowed area and a modification of the classical end-to-end anastomosis is applied in the form of an elongated or expanded variant. Recently, when proximal part is involved in the pathological process, cardiac surgeons have been more likely to use median sternotomy using other types of plastic surgery, including dilation of the narrowed area with a pericardial patch, or pulmonary artery tissue. Accordingly, the analysis of the results of the use of end-to-end anastomosis in young children with aortic arch hypoplasia, especially in view of long-term survival and the level of reoperation, is an important issue of neonatal cardiac surgery. The aim. To evaluate the effectiveness of the use of an extended end-to-end anastomosis after reconstruction of the aortic arch in children under 1 year of age. Materials and methods. The study material included 348 infants who underwent surgical correction of aortic arch hypoplasia through the method of extended end-to-end anastomosis from 2010 to 2020. The operations were performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and the Ukrainian Children’s Cardiac Center. The study group included only patients with two-ventricular physiology. There were 233 male patients (67%) and 115 female patients (33%). The mean age was 1.07 (0.20; 2.30) months, the mean weight was 3.89 (3.30; 4.90) kg, the mean body surface area was 0.23 (0.20; 0.28) m2. Diagnosis of aortic arch hypoplasia was based on two-dimensional echocardiography. Results. According to echocardiography, after surgery there was a significant decrease in the pressure gradient in the aortic arch from 48.3 ± 20.3 to 16 ± 6.9 (p<0.05), left ventricular PV increased significantly from 61.6 ± 12% to 66.3 ± 6.4% (p> 0.05). The hospital mortality was 1.7% (n = 6). The causes of mortality were not related to the end-to-end aortic arch technique. The duration of follow-up period ranged from 1 month to 9.3 years. Two deaths occurred in the follow-up period. Thirty-two (9.1%) patients developed aortic arch restenosis in the postoperative period. Balloon dilatation of restenosis was performed in 21 patients. Eleven patients underwent repeated aortic arch repair surgery through the median sternotomy. There were no central nervous system complications in the follow-up period. Conclusions. The use of an extended end-to-end anastomosis in the surgical treatment of aortic arch hypoplasia demon strates low hospital mortality and high long-term survival. Indications for the effective use of this type of reconstruction are hypoplasia of the isthmus and distal aortic arch.

scholarly journals Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

2007 ◽  
Vol 64 (7) ◽  
pp. 453-457
Author(s):  
Tamara Alempijevic ◽  
Vladislava Bulat ◽  
Nada Kovacevic ◽  
Rada Jesic ◽  
Srdjan Djuranovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Oesophageal Varices ◽  
Digestive Endoscopy ◽  
Liver Lobe ◽  
Albumin Ratio ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Upper Digestive Endoscopy ◽  
The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

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