Estudo sobre prevalência e impacto prognóstico da sarcopenia em portadores de cirrose hepática.

• Ano de defesa: 2018
• Autor(a) principal: Souza, Gabriela Morais De [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Cirrhosis; Prevalence; Prognosis; Sarcopenia; Cirrose; Prevalencia; Prognostico
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6584004; https://repositorio.unifesp.br/handle/11600/52999

Introduction: Sarcopenia is a common nutritional complication common in cirrhotic patients. It adversely affects functional status, disease progression, survival, quality of life, stress response and outcomes after hepatic transplantation, being associated with poor prognosis and occurrence of complications in these patients. The diversity and complexity of the methods currently used for the diagnosis of sarcopenia is evident. Objectives: 1) to evaluate the prevalence of functional sarcopenia; 2) to identify epidemiological, clinical and nutritional factors associated with the presence of functional sarcopenia; 3) to evaluate the concordance between functional and objective sarcopenia; and 4) to assess the impact of sarcopenia on the incidence of hepatic decompensation and on the overall survival. Methodology: a crosssectional study, carried out through clinical and nutritional evaluation of outpatients with liver cirrhosis, including measurement of handgrip strength (HGS) with dynamometry and L3 skeletal muscle mass index (SMIL3) obtained by CT for the diagnosis of functional and objective sarcopenia, respectively. Results: 69 patients were evaluated, with 87% of men. The mean age was 58.8 ± 10.1 years. Alcoholic liver disease was the most prevalent cause or cirrhosis (61%), followed by chronic infection with hepatitis C or B viruses (20%). The ChildPughTurcotte (CPT) classification defined 58% of the patients as CPTA, 32% CPTB and 9% CPTC, and the mean MELD (Model for EndStage Liver Disease) score was 11.8 ± 3.8. Diabetes mellitus was present in 38% of the patients, as well as systemic arterial hypertension (SAH) in 36%, ascites in 33% and peripheral edema in 20%. Laboratory evaluation revealed serum albumin lower than 3.5 g/dL in 33% of cases and anemia in 35% of the subjects. Nutritional status through body mass index evaluation considered 45% of the patients as eutrophic, 10% malnourished and 45% overweight and through the midarm circumference (MAC) 43% were eutrophic, 49% undernourished and 8% overweight. The mean HGS was 31.9 ± 9.5 kgf and the mean SMIL3 was 50.5 ± 8.6 cm2/m2. The mean caloric intake was 21.5 ± 8.6 kcal/kg/day and the mean protein intake was 0.9 ± 0.5 g/kg/day. Of the patients evaluated, 90% did not reach the ideal goal for daily caloric intake and 71% did not reach the protein goal. By the HGS, 52% of the patients exhibited functional sarcopenia, which was associated with absence of SAH (p = 0.011), presence of ascites (p = 0.011), low serum levels of albumin (p = 0.040) and sodium (p = 0.001), and lower values of MAC (p = 0.003) and corrected arm muscle area (CAMA; p = 0.001). Through IMML3, 39% of the patients showed objective sarcopenia. There was low concordance between HGS with dynamometry and SMIL3 by CT (kappa coefficient = 0.064). There was no significant association between the presence of functional sarcopenia and the incidence of hepatic decompensation and death during followup. Conclusions: the prevalence of sarcopenia was 52% using dynamometry and 39% using CT. Factors associated with the presence of sarcopenia by HGS include absence of SAH, presence of ascites, low serum levels of albumin and sodium, and lower values of MAC and CAMA. There was low concordance between the two criteria used for the diagnosis of sarcopenia, HGS and SMIL3. Functional sarcopenia had no significant impact on the incidence of hepatic decompensation or survival.