Lucas Homercher Galant

Functional status, respiratory muscle strength, and quality of life in patients with cirrhosis

BACKGROUND: Liver diseases are responsible for metabolic disorders and loss of muscle mass and function that affect functional status and quality of life (QoL). OBJECTIVE: To compare exercise capacity, respiratory muscle strength, and QoL in liver transplant candidates with cirrhosis of the following etiologies: hepatitis C virus (HCV), hepatitis B virus (HBV), and alcoholic cirrhosis (AC). METHODS: Cross-sectional study comprising 86 patients divided into three groups: HCV (40 patients), HBV (14 patients), and AC (32 patients). Patients were evaluated using the Six-Minute Walk Test (6MWT), manometry, and the QoL questionnaire SF-36. RESULTS: The AC group showed the lowest performance in the 6MWT (meters) compared to the HBV and HCV groups (373.50±50.48, 464.16±32, and 475.94±27.84, respectively, p=0.001). In the domains of the SF-36, the AC group had lower scores for functional capacity and physical limitations when compared to the HBV and HCV groups (p=0.001). In the comparison of respiratory muscle strength, the AC group had lower MIP (cmH2O) compared to the HBV and HCV groups (-65.54±11.28, -71.61±6.96, -82.44±13.71, respectively, p=0.001). The MEP (cmH2O) in the AC group was also lower than in the HBV and HCV groups (65.13±10.74, 82.44±13.87, 83.44±12.20, respectively, p=0.001). CONCLUSION: The AC group showed worse exercise capacity, respiratory muscle strength, and QoL compared to patients with HCV and HBV.BACKGROUND Liver diseases are responsible for metabolic disorders and loss of muscle mass and function that affect functional status and quality of life (QoL). OBJECTIVE To compare exercise capacity, respiratory muscle strength, and QoL in liver transplant candidates with cirrhosis of the following etiologies: hepatitis C virus (HCV), hepatitis B virus (HBV), and alcoholic cirrhosis (AC). METHODS Cross-sectional study comprising 86 patients divided into three groups: HCV (40 patients), HBV (14 patients), and AC (32 patients). Patients were evaluated using the Six-Minute Walk Test (6MWT), manometry, and the QoL questionnaire SF-36. RESULTS The AC group showed the lowest performance in the 6MWT (meters) compared to the HBV and HCV groups (373.50 ± 50.48, 464.16 ± 32, and 475.94 ± 27.84, respectively, p=0.001). In the domains of the SF-36, the AC group had lower scores for functional capacity and physical limitations when compared to the HBV and HCV groups (p=0.001). In the comparison of respiratory muscle strength, the AC group had lower MIP (cmH2O) compared to the HBV and HCV groups (-65.54 ± 11.28, -71.61 ± 6.96, -82.44 ± 13.71, respectively, p=0.001). The MEP (cmH2O) in the AC group was also lower than in the HBV and HCV groups (65.13 ± 10.74, 82.44 ± 13.87, 83.44 ± 12.20, respectively, p=0.001). CONCLUSION The AC group showed worse exercise capacity, respiratory muscle strength, and QoL compared to patients with HCV and HBV.

The aerobic capacity and muscle strength are correlated in candidates for liver transplantation

Liver diseases are responsible for metabolic and cardiorespiratory alterations. The objective of this paper is to correlate the maximal oxygen uptake (VO(2max)) and respiratory muscle strength and evaluating the quality of life in liver transplant candidates. Cross-sectional study consisted of 26 patients with cirrhosis who underwent maximal exercise testing, respiratory muscle strength and SF-36. There was a correlation of VO(2max) with MIP (r = 0.61) and low scores of quality of life. A correlation of VO(2max) to muscle strength and decreased quality of life in patients with liver disease.

Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis

Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below −70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above −70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis.

Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático

ABSTRACT Introduction: Chronic liver disease results in large functional impact, causing loss of muscle mass and function with consequent reduction of functional capacity. Objective: To evaluate and compare the respiratory muscle strength and functional capacity of candidates for liver transplantation who are under Class B or C according to Child Pugh Score and to correlate these variables within each group. Methods - Cross-sectional study with a convenience sample of 35 patients divided into two groups based on the score obtained in the Child Pugh Score B (19 patients) and Child Pugh Score C (16 patients). All subjects were evaluated in a single moment, and the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the distance walked during the 6-minute walk test (6MWT) were measured. Results: Individuals classified with Child Pugh Score B showed higher values in the MIP (- 86.05 vs. 23.89 - 57.94 14.14), p = 0.001, in MEP (84.16 vs. 28.26 72.00 16 1994), p = 0.142, and the distance walked in 6MWT (473.63 vs 376.13 39.00 55.276), p = 0.001. We also found a positive correlation between the values of MIP and distance walked during 6MWT in group B of the Child Pugh Score, r = 0.64 and p = 0.003. Conclusion: The progress of liver disease contributes to the onset of several complications, which together appear to contribute to the reduction of functional capacity of individuals. In our study this was evidenced by the worse performance of Child Pugh score C group. This may suggest that the wait for liver transplantation (LTx) can worsen the functional capacity of these individuals.Keywords: liver disease, functional capacity, respiratory muscle strength, Child-Pugh score.

RELIABILITY OF THE FATIGUE SEVERITY SCALE IN CIRRHOTIC AND CORRELATION WITH DEPRESSION AND QUALITY OF LIFE: preliminary assessment

BACKGROUND Fatigue is a common complaint in patients with liver disease and may be considered a disabling symptom, affecting their quality of life and mental health. The Brazilian version of the Fatigue Severity Scale showed sensitivity to assess fatigue in some populations, but has not been tested in cirrhotic individuals. OBJECTIVE The aim of this study was to evaluate the reliability of the Fatigue Severity Scale and association with depression and quality of life in patients with liver cirrhosis. METHODS A prospective cohort study where the same interviewer applied to 25 patients Fatigue Severity Scale questionnaires, Brazilian version of the Beck Depression Inventory II (BDI- II) and Brazilian version of the Short Form Health Survey II (SF-36 v.II). Evaluating the reliability of the Fatigue Severity Scale through internal consistency and reproducibility was conducted. RESULTS Statistical analysis showed strong internal consistency (Cronbachs alpha = 0.917) and intraobserver reproducibility test, there was no significant difference between both moments (P=0.828). Fatigue Severity Scale was significantly associated with BDI- II (r=0.478; P=0.016) and quality of life in areas PF (r=-0.484; P=0.014), BP (r=-0.402; P=0.046) and GH (r=-0.406; P=0.044) and SF (r=-0.520; P=0.008). CONCLUSION The Fatigue Severity Scale showed satisfactory reliability in evaluation of fatigue in cirrhotic and can be used as a tool for this purpose. Fatigue is related to depression and quality of life in the physical aspects domains, pain, general health and social aspects.

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

PSYCHOMETRIC PROPERTY OF FATIGUE SEVERITY SCALE AND CORRELATION WITH DEPRESSION AND QUALITY OF LIFE IN CIRRHOTICS

BACKGROUND Fatigue is a common complaint in cirrhotic patients and may be considered a debilitating symptom with negative impact on quality of life. Research on its etiology and treatment has been hampered by the lack of relevant and reproducible measures of fatigue. OBJECTIVE To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in cirrhotic patients and to correlate with depressive symptomatology and quality of life. METHODS Cross-sectional study with a convenience sample of 106 cirrhotic patients, aged between 18 and 70 years, both genders, literate, pre and post liver transplantation in outpatient follow-up. Internal consistency, reproducibility, discriminant validity, criterion validity, construct validity, responsiveness criterion, depressive symptomatology and quality of life were evaluated through questionnaires between January and October 2015. RESULTS The mean age was 54.75±9.9 years, 65.1% male and 32.1% of the sample had cirrhosis due to hepatitis C virus. The mean FSS score was 4.74±1.64. Cronbachs alpha was 0.93, and the Intraclass Correlation Coefficient was 0.905 (95% CI: 0.813-0.952). For discriminant validity, FSS differentiated scores from different groups (P=0.009) and presented a correlation with the Modified Fatigue Impact Scale (r=0.606, P=0.002). FSS correlated significantly and positively with depressive symptomatology and correlated negatively with the SF-36 domains for construct validity. For responsiveness, no significant changes were observed in the fatigue scores in the pre and post-liver transplantation periods (P=0.327). CONCLUSION FSS showed good psychometric performance in the evaluation of fatigue in patients with cirrhosis. Fatigue presented a strong correlation with depressive symptomatology and quality of life.

Alterações cardíacas e qualidade de vida em doentes hepáticos candidatos ao transplante ortotópico de fígado - DOI: http://dx.doi.org/10.15602/1983-9480/cmbs.v13n27p27-33

RESUMO Este trabalho tem como objetivo avaliar as alterações da função cardíaca e correlacioná-las com a qualidade de vida em pacientes candidatos ao transplante hepático, a partir da etiologia da doença hepática. Estudo transversal, composto por 64 pacientes divididos em: grupo 1 de etiologia alcoólica, 2 de hepatite pelo vírus B e o 3 hepatite pelo vírus C. Todos os indivíduos realizaram o exame de Eco e responderam o questionário de qualidade de vida Short Form -36. Na Eco foi encontrada diferença significativa entre os grupos 1 e 2 em relação ao diâmetro do ventrículo direito (p = 0,03), entre os grupo 1 e 3 em relação à fração de ejeção(p = 0,0001) e o grupo 1 diferiu dos demais grupos na variável massa ventricular esquerda (p = 0,0001). Quanto à análise da qualidade de vida entre os grupos, houve diferença estatisticamente significativa entre o grupo 1 e os demais grupos nos domínios capacidade funcional (p = 0,0001) e limitação por aspectos físicos (p = 0,0001). Houve correlação entre os domínios do questionário de qualidade de vida e as variáveis da Ecoddoplercardiografia como a capacidade funcional e a FE (r = 0,35; p = 0,006) e a Massa ventricular esquerda (r = -0,52; p = 0,0001). Essas variáveis também se correlacionaram com a limitação por aspectos físicos (r = 0,43; p = 0,001) e (r = -0,48; p = 0,0001), respectivamente. As alterações cardíacas influenciam negativamente a qualidade de vida, ocorrendo maior alteração em pacientes com diagnóstico de cirrose alcoólica.