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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Six-minute walking test performance is associated with survival in cirrhotic patients
Carolina Frade M G Pimentel, Ana Cristina de Castro Amaral, Adriano Miziara Gonzalez, Michelle Lai, Daniel de Oliveira Mota, Maria Lucia Gomes Ferraz, Wilson Mathias Junior, Mario Kondo
Carolina Frade M G Pimentel, Department of Medicine, Federal University of Sao Paulo, Sao Paulo 04026090, Brazil
Ana Cristina de Castro Amaral, Maria Lucia Gomes Ferraz, Mario Kondo, Department of Gastroenterology, Federal University of Sao Paulo, Sao Paulo 04023062, Brazil
Adriano Miziara Gonzalez, Department of Surgery, Liver Transplantation Service, Federal University of Sao Paulo, Sao Paulo 04026090, Brazil
Michelle Lai, Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Daniel de Oliveira Mota, Department of Industrial Engineering, University of Sao Paulo, Sao Paulo 05508010, Brazil
Wilson Mathias Junior, Department of Cardiology, Heart Institute, University of Sao Paulo, Sao Paulo 05403900, Brazil
Author contributions: All authors of this manuscript contributed to its developing; Carolina PFMG, Amaral ACC, Gonzalez AM, Lai M, Mota DO, Ferraz ML, Junior WM, and Kondo M responsible for conception and design of the study, and interpretation of the data, making critical revisions and final approval of the version of the article to be published; Carolina PFMG, Lai M, and Kondo M drafted the article; Carolina PFMG and Kondo M contributed to acquisition of data and analysis.
Institutional review board statement: The study has been performed in accordance with the Declaration of Helsinki (2000) and approved by the Ethics Committee of our institution, Federal University of Sao Paulo, Brazil (CAAE: 30942714.8.0000.5505; May 28, 2014).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors of this study have no conflict of interest to be declared.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
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: Carolina Frade M G Pimentel, MD, Professor, Department of Medicine, Federal University of Sao Paulo, Botucatu Street n 740, Sao Paulo 04026090, Brazil.
carolinapimentel.gastro@gmail.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: May 13, 2021
Revised: May 18, 2021
Accepted: October 12, 2021
Article in press: October 12, 2021
Published online: November 27, 2021
Processing time: 287 Days and 20.7 Hours
BACKGROUND
Patients with cirrhosis are at risk of cirrhotic cardiomyopathy, with resulting cardiac dysfunction and exercise limitations. Six minute walking test (6MWT) assesses functional status and predicts morbidity and mortality in cardiopulmonary diseases.
AIM
To determine if it associates with mortality by analyzing 6MWT performance in patients with liver cirrhosis.
METHODS
A cohort of 106 cirrhotic patients was evaluated in the outpatient setting with echocardiogram and 6MWT and follow up for one year to document hepatic decompensation and mortality. The distance in meters was recorded at the end of 6 min (6MWD).
RESULTS
This cohort had a mean age of 51 years and 56% male; patients were staged as Child A in 21.7%, B 66% and C 12.3%. Walk distance inversely correlated with Child scores, and was significantly reduced as Child stages progresses. Patients who died (10.4%) showed shorter mean 6MWD (P = 0.006). Low 6MWD was an independent predictor of mortality (P = 0.01).
CONCLUSION
6MWT is a noninvasive inexpensive test whose result is related to Child scores and mortality. It is useful to identify patients with liver cirrhosis at high risk of mortality for closer monitoring and potential early intervention.
Core Tip: Our study proposes that six-minute walking test, a simple exercise test, can be applicable in the evaluation of cirrhotic patients. This is a well-none routine assessment in patients with cardiopulmonary diseases, where it is used to predict mortality in this population. Its use in liver cirrhosis is limited. Patients with chronic hepatic insufficient are at risk of progressively muscle loss, frailty, and exercise limitation, all factors directly associated with poor survival. We propose by using six-minute walk test a practical and simple manner of assess this risks and provide a better understanding of how exercise limitation can directly affect survival.
