Daphne Bot1, Anneke Droop2, Claudia J Lucassen2, Mariëlle E van Veen2, Jeroen L A van Vugt3, Shirin Shahbazi Feshtali4, Eva Leistra5, Maarten E Tushuizen6, Bart van Hoek6. 1. Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: d.bot@lumc.nl. 2. Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 4. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Health Sciences, Faculty of Science, VU University, Amsterdam, the Netherlands. 6. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
Abstract
BACKGROUND AND AIMS: Malnutrition is highly prevalent in patients with end-stage liver disease (ESLD) and associated with impaired clinical outcome. Previous studies focused on one component of body composition and not in combination with nutritional intake, while both are components of the nutritional status. We aimed to evaluate the most important risk factors regarding body composition (muscle mass, muscle quality and fat mass) and nutritional intake (energy and protein intake) for waiting list mortality in patients with ESLD awaiting liver transplantation (LTx). METHODS: Consecutive patients with ESLD listed for LTx between 2007 and 2014 were investigated. Muscle mass quantity (Skeletal Muscle Mass Index, SMI), and muscle quality (Muscle Attenuation, MA), and various body fat compartments were measured on computed tomography using SliceOmatic. Nutritional intake (e.g. energy and protein intake) was assessed. Multivariable stepwise forward Cox regression analysis was used for statistical analysis. RESULTS: 261 Patients (mean age 54 years, 74.7% male) were included. Low SMI and MA were found to be statistically significant predictors of an increased risk for waiting list mortality in patients with ESLD, with a HR of 2.580 (95%CI 1.055-6.308) and HR of 9.124 (95%CI 2.871-28.970), respectively. No association between percentage adipose tissue, and protein and energy intake with waiting list mortality was found in this study. CONCLUSION: Both low muscle quantity and quality, and not nutritional intake, were independent risk factors for mortality in patients with ESLD.
BACKGROUND AND AIMS: Malnutrition is highly prevalent in patients with end-stage liver disease (ESLD) and associated with impaired clinical outcome. Previous studies focused on one component of body composition and not in combination with nutritional intake, while both are components of the nutritional status. We aimed to evaluate the most important risk factors regarding body composition (muscle mass, muscle quality and fat mass) and nutritional intake (energy and protein intake) for waiting list mortality in patients with ESLD awaiting liver transplantation (LTx). METHODS: Consecutive patients with ESLD listed for LTx between 2007 and 2014 were investigated. Muscle mass quantity (Skeletal Muscle Mass Index, SMI), and muscle quality (Muscle Attenuation, MA), and various body fat compartments were measured on computed tomography using SliceOmatic. Nutritional intake (e.g. energy and protein intake) was assessed. Multivariable stepwise forward Cox regression analysis was used for statistical analysis. RESULTS: 261 Patients (mean age 54 years, 74.7% male) were included. Low SMI and MA were found to be statistically significant predictors of an increased risk for waiting list mortality in patients with ESLD, with a HR of 2.580 (95%CI 1.055-6.308) and HR of 9.124 (95%CI 2.871-28.970), respectively. No association between percentage adipose tissue, and protein and energy intake with waiting list mortality was found in this study. CONCLUSION: Both low muscle quantity and quality, and not nutritional intake, were independent risk factors for mortality in patients with ESLD.