201 CORTICOSTEROIDS IMPROVE 28-DAY SURVIVAL IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS: INDIVIDUAL DATA ANALYSIS OF THE LAST 5 RANDOMIZED CONTROLLED TRIALS
2009; Elsevier BV; Volume: 50; Linguagem: Inglês
10.1016/s0168-8278(09)60203-8
ISSN1600-0641
AutoresPhilippe Mathurin, Justin O’Grady, Robert L. Carithers, M. Phillips, Marie-José Ramond, Alexandre Louvet, Hélène Castel, Sylvie Naveau, Timothy M. Morgan, Willis C. Maddrey, C L Mendenhall,
Tópico(s)Liver Disease and Transplantation
ResumoObesity, defined as a body mass index (BMI) 30 kg/m 2 , is associated with multiple chronic medical conditions.The impact of obesity on patients with end-stage liver disease (ESLD) has not been clearly established.We hypothesized that individuals with ESLD and BMI 30 were at higher risk of morbidity and mortality while awaiting liver transplantation (LT).Aim: To compare outcomes of patients with ESLD referred for LT with BMI 30 vs. those with BMI < 30.Methods: A retrospective review of all patients presented to our center's LT selection committee in 2005 was performed.Complications of ESLD, hospitalization and mortality rates pre-LT were recorded.BMI was calculated at the initial visit.Results: Of 421 patients, 273 (65%) were male.The median patient age was 56 years.278 patients (66%) had BMI < 30 and 143 (34%) had BMI 30, of which 54 were morbidly obese (BMI 35).141 patients were overweight (25 BMI < 30).The most common etiologies for ESLD were HCV (36%), alcohol related liver disease (16%) and cryptogenic cirrhosis (13%).In the cohort, 54% of patients with BMI < 30 were listed for LT vs. 56% with BMI 30 (P = 0.65, chi-square test).There was no significant difference between groups in the rates of hospitalization, mortality after listing or LT (Table ).There was a small but significant difference in the median time from listing to LT between patients with BMI < 30 and those with BMI 30 of 34 versus 22 days, respectively (P = 0.036, log-rank test).Using Cox regression analysis, the significant variables for LT were MELD score (P < 0.001), creatinine clearance (P = 0.042) and age (P = 0.041). Conclusion:In our cohort, obesity was not associated with an increased risk of complications or mortality while awaiting LT or a reduced likelihood of undergoing LT.
Referência(s)