A total of 1,053 cirrhotic patients were included in a prospective study to determine whether malnutrition is a risk factor for mortality in cirrhotic patients. Child-Pugh classification as well as clinical and biochemical variables were used to assess the severity of cirrhosis. Nutritional status was evaluated both by anthropometric and clinical measurements. Patients were defined as malnourished when midarm muscle area (MAMA) and/or midarm fat area (MAFA) were below the 5th percentile of an age- and sex-matched population. During follow-up, 419 patients died. The estimated survival rate was 82.7% at 1 year, 65.1% at 3 years, and 50.7% at 5 years. The presence of muscle depletion and/or of a steep reduction in fat deposits was associated with a higher risk of mortality (midarm muscle area, < 5th percentile, relative risk = 1.79; midarm fat area, < 5th percentile, relative risk = 1.35). When patients were stratified according to the Child-Pugh classification, cumulative survival was lower in patients with a reduction in muscle mass in Child-Pugh classes A and B (log rankP = .027; P = .022, respectively) but not in class C. Conversely, a significant reduction in adipose tissue deposits appeared to have no independent impact on survival in any Child-Pugh class. When examined using a multivariate Cox proportional hazard analysis, age, sex, bilirubin, cholinesterase, ascites, and esophageal varices were selected, whereas the parameters of nutritional status were not. This suggests that malnutrition, while strongly associated with the deterioration of liver function, cannot be considered an independent risk factor for mortality in a general population of cirrhotic patients.

译文

一项前瞻性研究共纳入了1,053例肝硬化患者,以确定营养不良是否是肝硬化患者死亡的危险因素。Child-Pugh分类以及临床和生化变量用于评估肝硬化的严重程度。通过人体测量和临床测量评估营养状况。当中臂肌肉区域 (MAMA) 和/或中臂脂肪区域 (MAFA) 低于年龄和性别匹配人群的第5个百分位数时,患者被定义为营养不良。在随访期间,有419名患者死亡。估计生存率在1年时82.7%,3年时65.1%,5年时50.7%。肌肉耗竭和/或脂肪沉积急剧减少的存在与较高的死亡率风险相关 (中臂肌肉面积,<第5百分位,相对风险 = 1.79; 中臂脂肪面积,<第5百分位,相对风险 = 1.35)。当根据Child-Pugh分类对患者进行分层时,Child-Pugh a级和B级肌肉质量减少的患者的累积生存率较低 (log rankP = .027; P = .022),但C级则没有。相反,在任何Child-Pugh类别中,脂肪组织沉积物的显着减少似乎对生存率没有独立影响。当使用多变量Cox比例风险分析进行检查时,选择了年龄,性别,胆红素,胆碱酯酶,腹水和食管静脉曲张,而营养状况的参数则没有。这表明,营养不良虽然与肝功能恶化密切相关,但不能被视为肝硬化患者一般人群死亡的独立危险因素。

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