Produção Nacional
Revisado por pares
The clinical diagnosis of malnutrition predicts mortality better than low muscle mass and strength in cirrhotic patients
2023; Elsevier BV; Volume: 58; Linguagem: Inglês
10.1016/j.clnesp.2023.09.516
ISSN2405-4577
AutoresLucilene Rezende Anastácio, Bárbara Chaves Santos, Ana Luísa Ferreira Fonseca, Beatriz da Costa Aguiar Alves, Camila Saueressig, Carla Cunha, Lívia Garcia Ferreira, Lucivalda Pereira Magalhães de Oliveira, R. S. S. B. Boulhosa, Rosângela Passos de Jesús, Samanta Catherine Ferreira, Valesca Dall’Alba, Vivian Cristine Luft, Yani Gláucia Gomide Mizubuti, María Isabel Toulson Davisson Correia,
Tópico(s)Liver Disease and Transplantation
ResumoRationale: Malnutrition which encompasses low muscle mass, and strength are common in patients with cirrhosis. It was our goal to determine if the clinical assessment of malnutrition by Subjective Global Assessment (SGA) predicts mortality better than objective evaluations. Methods: This is the analysis of cohort databases from different Brazilian regions, collected in four reference centers: Hospital das Clínicas da UFMG (n=408), de Salvador-HUPES/UFBA (n=277), and de Porto Alegre/UFRGS (n=113). Patients were assessed prospectively for mortality, one year after the initial evaluation. The clinical diagnosis was carried out by the SGA, and those diagnosed as moderately and severely malnourished were grouped; low muscle mass was diagnosed by muscle arm circumference (≤21.5cm for women and ≤24.2cm for men) and for low muscle strength, dynamometry was done (highest or average value for non-dominant hand:≤27kgf and ≤16kgf for men and women aged<60y, and ≤21kgf and ≤12kgf for men and women aged≥60y, respectively). Accuracy (ROC curve), sensibility; specificity and relative risk (RR) were tested. Results: 798 patients with cirrhosis (68% men; 54.2±11.8y; 50.6% Child B) were included. The diagnosis of malnutrition by SGA, low muscle mass and low muscle strength were found in 60.7%; 44.5% and 42.7%, respectively.The clinical diagnosis of malnutrition had the greatest sensibility, accuracy, and RR to predict one year mortality. Low muscle mass and strength also predicted mortality, but 73% of these patients were also malnourished.Tabled 1Table 1. Prediction of mortality by SGA, low muscle mass and strength in patients with cirrhosisSensibility/SpecificityAccuracyRR (95%CI)Malnutrition by SGA86.0%/46.3%0.6615.32 (3.36-8.42)Low muscle mass52.3%/57.6%0.5501.49 (1.06-2.09)Low muscle strength63.4%/62.9%0.6312.94 (2.07-4.17) Open table in a new tab Conclusion: SGA was able to best predict mortality in patients with cirrhosis. Disclosure of Interest: None declared
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