scholarly journals Sarcopenia—The Impact on Physical Capacity of Liver Transplant Patients

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 740
Author(s):  
Maciej Miarka ◽  
Krzysztof Gibiński ◽  
Maciej K. Janik ◽  
Renata Główczyńska ◽  
Krzysztof Zając ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Common Factor ◽  
Lumbar Vertebra ◽  
Peak Oxygen Uptake ◽  
Cardiac Biomarkers ◽  
Skeletal Muscle Index ◽  
Icu Stay ◽  
Prolonged Icu Stay ◽  
Related Liver Disease ◽  
The Impact

Optimizing patients’ condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = −0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

The impact of sarcopenia and myosteatosis in liver transplant candidates on peritransplant course and patient and graft survival

2021 ◽  
Vol 75 (4) ◽  
pp. 311-322
Author(s):  
Irena Míková ◽  
Denisa Kyselová ◽  
Dana Kautznerová ◽  
Marek Tupý ◽  
Marek Kysela ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Blood Transfusions ◽  
Term Survival ◽  
Skeletal Muscle Index ◽  
Long Term Survival ◽  
Psoas Major Muscle ◽  
The Impact ◽  
Patient And Graft Survival

Introduction: Sarcopenia (severe muscle depletion) and myosteaosis (pathological fat accumulation in muscle) are frequent muscle abnormalities in patients with cirrhosis associated with unfavorable prognosis. The aim of our study was to evaluate the impact of sarcopenia and myosteatosis in liver transplant (LT) candidates in our center on the peritransplant course and patient and graft survival. Methods: This prospective study included adult LT candidates who underwent clinical and laboratory examination. The skeletal muscle index (SMI) at L3 level and radiodensity of psoas major muscle (PM-RA) were evaluated by CT. Results: Pretransplant sarcopenia was found in 49 of 103 patients (47.6%) and myosteatosis in 53 (51.5%) patients. Patients with sarcopenia had lower BMI, waist circumference, occurrence of hypertension and metabolic syndrome and lower triglyceride and C-peptide levels than patients without sarcopenia. Patients with myosteatosis had higher Child-Pugh score and lower HDL-cholesterol levels than patients without myosteatosis. Pretransplant SMI negatively correlated with the amount of blood transfusions given during LT and occurrence of biliary complications. Patients with myosteatosis had higher need for blood transfusions during LT and after LT, and higher number of surgical revisions. Occurrence of sarcopenia had no significant effect on patient and graft survival. Patients with myosteatosis had worse long-term survival than patients without myosteatosis, the graft survival did not differ. Conclusion: Sarcopenia and myosteatosis are frequent muscle abnormalities in LT candidates with negative impact on peritransplant course. Myosteatosis was associated with a worse long-term survival in our study. Key words: sarcopenia – myosteatosis – liver transplantation – prevalence – complications – survival

scholarly journals The Impact of an ICU Liaison Nurse on Discharge Delay in Patients after Prolonged ICU Stay

2006 ◽  
Vol 34 (1) ◽  
pp. 55-60 ◽  
Author(s):  
W. Chaboyer ◽  
L. Thalib ◽  
M. Foster ◽  
D. Elliott ◽  
R. Endacott ◽  
...  
Keyword(s):  
Icu Stay ◽  
Prolonged Icu Stay ◽  
The Impact ◽  
Liaison Nurse

scholarly journals THE IMPACT OF “SIX-MONTH RULE” ON LIVER TRANSPLANT OUTCOME IN PATIENTS WITH ALCOHOL RELATED LIVER DISEASE

2020 ◽  
Vol 104 (S3) ◽  
pp. S493-S493
Author(s):  
Kenji Okumura ◽  
Asad Azim ◽  
Inkyu Lee ◽  
Gregory Veillette ◽  
Hiroshi Sogawa ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Transplant Outcome ◽  
Related Liver Disease ◽  
The Impact

scholarly journals The prevalence and the impact of sarcopenia in digestive cancers. A Systematic Review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Carmen Haiducu ◽  
Adrian Buzea ◽  
Liliana Elena Mirea ◽  
Gheorghe Andrei Dan
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Selection Process ◽  
Lumbar Vertebra ◽  
Negative Consequences ◽  
Digestive Cancer ◽  
Skeletal Muscle Index ◽  
Pubmed Database ◽  
Digestive Cancers ◽  
The Impact

Abstract Introduction: Sarcopenia is characterized by a decrease in skeletal muscle mass, associated with low muscle strength and/or poor physical performance. Assessing the prevalence of sarcopenia among digestive cancers and establishing the impact that sarcopenia has on the postoperative evolution of digestive tumors may be a central pillar in improving postoperative outcomes by caring for perioperative sarcopenia. This brief review aimed to evaluate the prevalence of sarcopenia in digestive cancer patients. Method and materials: PubMed database was searched for” sarcopenia” AND” digestive cancers” from January 1st, 2010, through September 30th, 2020. PRISMA guideline was used for this systematic review. After the selection process, 31 complete studies were included in our review. Assessment of sarcopenia diagnosis for the studies included in this systematic review was based on a computed tomographic calculation of the skeletal muscle index at the third lumbar vertebra. Results: Among a total of 11651 patients with digestive cancers, the prevalence of sarcopenia was 43.68%. The highest prevalence of sarcopenic patients was in esophageal (70.4%) and hepatic (60.3%) cancer, following by biliary tract (49.3%), pancreatic (45.70%), colorectal (42.83%), cancer, and gastric cancer (32.05%) with the lowest prevalence. The results of studies conducted by now regarding the prevalence of sarcopenia in digestive cancers and its relevance in the evolution of these cancers are discordant and uneven. Some studies show that the presence of sarcopenia in patients with digestive cancers is associated with an increased rate of postoperative complications, increased toxicity of chemotherapeutics and increased mortality. Other studies, do not find sarcopenia as an independent risk factor associated with negative consequences in the course of patients with digestive cancers. Conclusions: Sarcopenia is prevalent in digestive cancers. There is still no consensus about the impact of sarcopenia on the treatment of digestive cancers. Further studies are needed to evaluate the real consequences of sarcopenia in digestive cancers.

The impact of preoperative sarcopenia on postoperative complications following esophagectomy for esophageal neoplasia: a systematic review and meta-analysis

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Dimitrios Papaconstantinou ◽  
Konstantina Vretakakou ◽  
Anna Paspala ◽  
Evangelos P Misiakos ◽  
Anestis Charalampopoulos ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Performance Status ◽  
Random Effect ◽  
Random Effect Model ◽  
Cumulative Risk ◽  
Lumbar Vertebra ◽  
Skeletal Muscle Index ◽  
Significant Difference ◽  
The Impact

Summary Esophageal cancer is characterized by profound changes in body composition due to dysphagia and generalized cachexia. Sarcopenia or muscle wasting is a component of cachexia associated with poor postoperative performance status. The skeletal muscle index (SMI) calculated by computed tomography scans at the level of the third lumbar vertebra is an easily quantifiable and reproducible measure of sarcopenia. The aim of this meta-analysis is to investigate the impact of preoperative sarcopenia (low SMI) on postoperative complications after esophagectomy for neoplastic lesions. In this context, a comprehensive literature search was undertaken to identify studies reporting short-term postoperative outcomes in relation to their preoperative SMI values. Cumulative risk ratios (RR) and risk differences (RD) and their respective 95% confidence intervals (CIs) were calculated using a random-effect model. A total of 11 studies incorporating 1,979 total patients (964 patients with sarcopeniaversus 1,015 without sarcopenia) were included in the final analysis. The results demonstrated a significant increase in overall morbidity (RR 1.16, 95% CI 1.01–1.33), respiratory complications (RR 1.64, 95% CI 1.21–2.22) and anastomotic leaks (RR 1.39, 95% CI 1.10–1.76) in patients with sarcopenia. No statistically significant difference was noted in overall mortality (RD 0, 95% CI −0.02–0.02) or Clavien–Dindo grade III or greater complications (RR 1.17, 95% CI 0.96–1.42). The above results demonstrate the validity of the SMI as a predictive factor for post-esophagectomy complications. Although the risk associated with sarcopenia is not prohibitive for surgery, patients with low SMI require closer vigilance during their postoperative course due to the increased propensity for respiratory and anastomotic complications.

Risk Factors of Prolonged ICU Stay in Liver Transplant Recipients in a Single-Center Experience

2018 ◽  
Vol 50 (7) ◽  
pp. 2014-2017 ◽  
Author(s):  
G. Niewińsk ◽  
J. Raszeja-Wyszomirska ◽  
R. Główczyńska ◽  
W. Figiel ◽  
K. Zając ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplant ◽  
Transplant Recipients ◽  
Single Center ◽  
Icu Stay ◽  
Single Center Experience ◽  
Prolonged Icu Stay ◽  
Liver Transplant Recipients

scholarly journals Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Michel Teuben ◽  
Roy Spijkerman ◽  
Taco Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Mental Status ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Injury ◽  
Icu Stay ◽  
Severity Scores ◽  
Gcs Score ◽  
The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

scholarly journals Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Françoise Rousseau ◽  
Pauline Minguet ◽  
Camille Colson ◽  
Isabelle Kellens ◽  
Sourour Chaabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Inpatient Rehabilitation ◽  
Quadriceps Strength ◽  
Biological Parameters ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
Post Intensive Care Syndrome

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

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