Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.238
Peer-review started: July 2, 2023
First decision: July 5, 2023
Revised: July 16, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: September 20, 2023
Processing time: 79 Days and 12.9 Hours
The number of new cases of cirrhotic patients is growing worldwide and, as a consequence, an increase in the demand for specialized care to treat the disease per se and the complications inherent in cirrhosis, in addition to the increase in patients on the waiting list for orthotopic transplantation of liver. Given this scenario, it is necessary to identify a tool to predict the mortality of these patients linked to their clinical condition. Within this perspective, the phase angle (PA) becomes a good alternative because it is a viable method in clinical practice, with the potential to guide the clinical management of the patient and extend their survival time and better quality of life.
Identifying a tool capable of predicting mortality and severity of chronic liver disease in real time as a clinical practice brings numerous benefits to this population and to the professionals who treat them.
To the best of our knowledge, no study has evaluated the role of PA as a predictor of mortality in cirrhotic patients with a 15-year follow-up.
Retrospective cohort study with 129 cirrhotic patients of both genders aged over 18 years. Diagnosis of cirrhosis by liver biopsy. The cut-off value for the PA was 5.4°, a value described in 2012 by Fernandes et al for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles (P), as described by Mattiello et al. Mortality was assessed using the PA percentile using Kaplan-Meier curves and multivariate binary logistic regression models.
The percentile ranking was more accurate in identifying long-term deaths than the 5.4th PA. Patients with < P50 had a higher number of relevant complications, such as ascites, SBP, liver encephalopathy and HCC. PA is strongly correlated with serum albumin (P < 0.001), INR (P = 0.01), total bilirubin (P = 0.02) and direct bilirubin (p = 0.003). PA is correlated with survival time (P < 0.001) and length of stay (P = 0.02). Logistic regression analysis shows that a 1° increase in PA increases the chance of survival of cirrhotic patients by 17.7%.
PA is a good predictor of morbidity and mortality for cirrhotic patients.
Identifying clinical factors that enhance a poor prognosis for cirrhotic patients, such as ascites, encephalopathy, length of stay, is relevant. With this information, it is possible to act early in the clinical management of these patients and increase the effectiveness of the therapeutic response, with consequent improvement in the prognosis and quality of life of this population.