Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10871-10883
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10871
Value of the controlling nutritional status score and psoas muscle thickness per height in predicting prognosis in liver transplantation
Xing Dai, Ben Gao, Xin-Xin Zhang, Jiang Li, Wen-Tao Jiang
Xing Dai, Ben Gao, Department of Liver Transplant, The First Central College of Tianjin Medical University, Tianjin 300110, China
Xin-Xin Zhang, Department of Endocrinology, Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin 300134, China
Jiang Li, Wen-Tao Jiang, Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300110, China
Author contributions: Dai X designed the project, analyzed data, prepared figures, and wrote the manuscript; Li J conceived the study, supervised the results, critically revised/wrote the manuscript, and was responsible for its financial support and the corresponding works; All the other authors conceived the study, critically revised the manuscript and approved the final manuscript.
Supported by Nation Natural Science Foundation of China (General Program), No. 81870444; Natural Science Foundation of Tianjin, No. 17JCQNJC12800.
Institutional review board statement: This study was approved by the Human Research Committee of The First Central College of Tianjin Medical University.
Informed consent statement: Informed written consent was obtained from the patient for publication of this study and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang Li, MD, PhD, Associate Professor, Surgeon, Department of Liver Transplant, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300110, China. lijiang_009@163.com
Received: May 30, 2021
Peer-review started: May 30, 2021
First decision: July 14, 2021
Revised: July 14, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: December 16, 2021
Processing time: 193 Days and 24 Hours
ARTICLE HIGHLIGHTS
Research background

Patients with end-stage liver disease usually have varying degrees of malnutrition, and severe malnutrition may affect the prognosis of patients after liver transplantation (LT). However, whether malnutrition has an impact on the occurrence of postoperative complications in not known, and there is no unified standard for the nutrition assessment of patients waiting for LT. This study included 313 patients from single center in China, and statistically analyzed the predictive value of the two nutrition assessments, the controlling nutritional status (CONUT) score and psoas muscle thickness per height (PMTH) on prognosis in LT.

Research motivation

The study aimed to investigate the relationship between nutrition and prognosis of LT.

Research objectives

This study was designed to find the right nutrition assessment tools of patients waiting for LT and investigate the predictive value of tools on prognosis in LT.

Research methods

This was a retrospective study that included 313 patients from a single center undergoing orthotopic liver transplantation. Patients were divided into two or three groups, independent sample t tests, Mann-Whitney U or Kruskal-Wallis tests were used to compare intergroup perioperative data. Fisher’s exact or 2 tests were used to compare numbers and percentages of cases. Cumulative 3-mo survival rates were estimated by the Kaplan-Meier method.

Research results

Patients in the medium and high CONUT score groups had a lower preoperative serum hemoglobin levels, more intraoperative red blood cell (RBC) transfusions, longer postoperative intensive care unit and hospital stays, higher preoperative day 7 and day 14 serum bilirubin levels, and a higher incidence of postoperative grade III/IV complications and infections than patients in the low CONUT score group. There were no significant differences in the 3-mo cumulative survival rate among the three groups. Patients with a low PMTH had higher levels of preoperative serum urea nitrogen, more intraoperative packed RBC and frozen plasma transfusions, longer postoperative ventilator extubation times, an increased incidence of total postoperative complications, and a lower 3-mo cumulative survival rate than those with a high PMTH.

Research conclusions

A CONUT score ≥ 5 was associated with the incidence of grade III/IV/V complications and infection after LT, and a low PMTH was associated with the incidence of total complications after LT. The CONUT score had no predictive value for short-term patient survival after LT, and the PMTH was predictive of short-term patient survival after LT.

Research perspectives

We hope to develop a predictive model for poor clinical outcomes of LT that combines the CONUT score and PMTH so that the two tools can be used together to predict outcomes in a wider audience.