Do Child–Turcotte–Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study

Table 1 Sample characterization (n = 129), mean ± SD/ n (%)

Descriptive variables
Gender
Male	73 (56.59)
Female	56 (43.41)
Death
Yes	74 (57.36)
No	55 (42.64)
Transplanted
No	111 (86.05)
Yes	18 (13.95)
Cirrhosis etiology
Alcohol	31 (24.03)
Autoimmune	5 (3.88)
Cryptogenic NASH	5 (3.88)
Virus C + alcohol	14 (10.85)
Virus B + C + alcohol	12 (9.3)
Virus B + alcohol	1 (0.78)
Virus C	1 (0.78)
Virus B	56 (43.41)
Other	4 (3.1)
Child–Turcotte–Pugh
1	85 (65.89)
2	33 (25.58)
3	11 (8.53)
Continuous variables
Age (yr)	56.32 ± 11.252
Survival time (mo)	110.901 ± 73.139
Survival time (yr)	9.115 ± 6.011
Height (cm)	164.438 ± 8.979
First assessment weight (kg)	74.467 ± 14.692
Body mass index	27.528 ± 4.85
Arm circumference (cm)	30.538 ± 4.237
Muscle arm circumference (cm/mm)	24.791 ± 3.221
Bioimpedance analysis-phase angle (°)	6.62 ± 2.953
MELD	10.987 ± 4.699

NASH: Nonalcoholic steatohepatitis; MELD: Model for end-stage liver disease.

Table 2 Sample characterization categorized by Triceps skinfold and Child–Turcotte–Pugh score (n = 129), mean ± SD/n (%)

Descriptive variables	Categorized by TSF			P value	Categorized by Child–Turcotte–Pugh				P value
	1	2	3		1	2		3
	24 (18.6)	53 (41.09)	52 (40.31)		85 (65.89)	33 (25.58)		11 (8.53)
Gender				0.005					0.404
Male	9 (37.5)	26 (49.06)	38 (73.08)		45 (52.94)	20 (60.61)		8 (72.73)
Female	15 (62.5)	27 (50.94)	14 (26.92)		40 (47.06)	13 (39.39)		3 (27.27)
Death				0.817					0.013
Yes	15 (62.5)	29 (54.72)	30 (57.69)		41 (48.24)	25 (75.76)		8 (72.73)
No	9 (37.5)	24 (45.28)	22 (42.31)		44 (51.76)	8 (24.24)		3 (27.27)
Transplanted				0.683					0.025
No	22 (91.67)	45 (84.91)	44 (84.62)		78 (91.76)	24 (72.73)		9 (81.82)
Yes	2 (8.33)	8 (15.09)	8 (15.38)		7 (8.24)	9 (27.27)		2 (18.18)
Cirrhosis etiology				0.981					0.178
Alcohol	4 (16.67)	13 (24.53)	14 (26.92)		25 (29.41)	4 (12.12)		2 (18.18)
Autoimmune	0 (0)	3 (5.66)	2 (3.85)		5 (5.88)	0 (0)		0 (0)
Cryptogenic-NASH	2 (8.33)	2 (3.77)	1 (1.92)		3 (3.53)	2 (6.06)		0 (0)
Virus C + alcohol	4 (16.67)	4 (7.55)	6 (11.54)		9 (10.59)	5 (15.15)		0 (0)
Virus B + C + alcohol	3 (12.5)	6 (11.32)	3 (5.77)		5 (5.88)	4 (12.12)		3 (27.27)
Virus B + alcohol	1 (4.17)	0 (0)	0 (0)		0 (0)	0 (0)		1 (9.09)
Virus C	0 (0)	0 (0)	1 (1.92)		0 (0)	1 (3.03)		0 (0)
Virus B	10 (41.67)	23 (43.4)	23 (44.23)		36 (42.35)	15 (45.45)		5 (45.45)
Other	0 (0)	2 (3.77)	2 (3.85)		2 (2.35)	2 (6.06)		0 (0)
Ascites				0.519					0.001
Yes	12 (50)	34 (64.15)	28 (53.85)		40 (47.06)	25 (75.76)		9 (81.82)
No	12 (50)	19 (35.85)	23 (44.23)		45 (52.94)	7 (21.21)		2 (18.18)
Paracentesis				0.980					0.311
Yes	8 (33.33)	17 (32.08)	14 (26.92)		20 (23.53)	13 (39.39)		6 (54.55)
No	16 (66.67)	35 (66.04)	36 (69.23)		62 (72.94)	20 (60.61)		5 (45.45)
Esophageal varices				0.679					0.599
Yes	19 (79.17)	41 (77.36)	37 (71.15)		62 (72.94)	27 (81.82)		8 (72.73)
No	5 (20.83)	12 (22.64)	15 (28.85)		23 (27.06)	6 (18.18)		3 (27.27)
Varices bleeding				0.276					0.457
Yes	4 (16.67)	7 (13.21)	3 (5.77)		10 (11.76)	3 (9.09)		1 (9.09)
No	19 (79.17)	46 (86.79)	48 (92.31)		75 (88.24)	28 (84.85)		10 (90.91)
Encephalopathy				0.476					0.001
Yes	10 (41.67)	20 (37.74)	15 (28.85)		22 (25.88)	14 (42.42)		9 (81.82)
No	14 (58.33)	33 (62.26)	37 (71.15)		63 (74.12)	19 (57.58)		2 (18.18)
Encephalopathy level				0.299					0.001
0	14 (58.33)	33 (62.26)	37 (71.15)		63 (74.12)	19 (57.58)		2 (18.18)
1	4 (16.67)	6 (11.32)	8 (15.38)		11 (12.94)	4 (12.12)		3 (27.27)
2	2 (8.33)	11 (20.75)	5 (9.62)		6 (7.06)	8 (24.24)		4 (36.36)
3	4 (16.67)	3 (5.66)	1 (1.92)		4 (4.71)	2 (6.06)		2 (18.18)
4	0 (0)	0 (0)	1 (1.92)		1 (1.18)	0 (0)		0 (0)
Developed HCC				0.079					0.576
Yes	21 (87.5)	52 (98.11)	45 (86.54)		77 (90.59)	30 (90.91)		11 (100)
No	3 (12.5)	1 (1.89)	7 (13.46)		8 (9.41)	3 (9.09)		0 (0)
Continuous variables	TSF			P value	Child-Turcotte-Pugh				P value
	1	2	3		1	2		3
	24 (18.6)	53 (41.09)	52 (40.31)		85 (65.89)	33 (25.58)		11 (8.53)
Age (yr)	57.671 ± 8.837	56.156 ± 12.206	55.865 ± 11.382	0.804	55.942 ± 11.825	58.424 ± 10.417		52.937 ± 8.385	0.328
Survival time (mo)	98.715 ± 78.11	116.068 ± 74.444	111.258 ± 70.185	0.631	128.237 ± 68.005	81.32 ± 70.682		65.676 ± 77.103	0.001
Survival time (yr)	8.114 ± 6.42	9.54 ± 6.119	9.144 ± 5.769	0.631	10.54 ± 5.589	6.684 ± 5.809		5.398 ± 6.337	0.001
Height (cm)	161.333 ± 8.731	163.83 ± 8.733	166.49 ± 9	0.053	164.082 ± 8.597	164.955 ± 9.518		165.636 ± 10.847	0.806
First assessment weight (kg)	74.3 ± 10.434	66.517 ± 10.935	82.648 ± 15.389	0.000	72.445 ± 12.54	78.991 ± 18.539		76.527 ± 15.337	0.083
Body mass index	28.574 ± 4.052	24.816 ± 3.76	29.811 ± 4.872	0.000	26.868 ± 4.17	29.131 ± 6.005		27.821 ± 5.228	0.073
Arm circumference (cm)	31.222 ± 3.001	27.674 ± 3.968	33 ± 3.269	0.000	30.556 ± 4.122	30.778 ± 4.3		28.3 ± 5.078	0.262
Hospital admissions (n)	1.542 ± 2.167	1.811 ± 2.426	1.942 ± 2.653	0.807	1.576 ± 2.291	2.394 ± 3.02		1.909 ± 1.64	0.269
Length of stay (d)	9.94 ± 11.803	5.985 ± 8.494	5.751 ± 7.901	0.137	6.588 ± 9.23	6.692 ± 8.481		6.727 ± 10.031	0.998
MAC (cm/mm)	25.032 ± 2.515	23.975 ± 3.596	25.511 ± 2.957	0.045	24.779 ± 3.319	24.853 ± 2.903		24.696 ± 3.64	0.989
BIA-phase angle (°)	6.82 ± 3.912	6.348 ± 2.777	6.805 ± 2.645	0.686	6.903 ± 3.249	6.275 ± 2.42		5.474 ± 1.323	0.238
MELD	12.444 ± 5.217	10.704 ± 5.125	10.62 ± 3.899	0.350	8.647 ± 3.513	13.683 ± 3.028		17.208 ± 5.302	0.000

TSF: Triceps skinfold; MAC: Mid-arm muscle circumference; NASH: Nonalcoholic steatohepatitis; MELD: Model for end-stage liver disease; HCC: Hepatocellular carcinoma, BIA: Bioimpedance.

Table 3 Sample characterization categorized by subjective global assessment, muscle-arm circumference and handgrip strength (n = 129), mean ± SD/n (%)

Descriptive variables	SGA		P value	MAC		P value	Handgrip strength		P value
	1	2		1	2		1	2
	124 (96.12)	5 (3.88)		93 (72.09)	36 (27.91)		53 (41.09)	76 (58.91)
Gender			0.699			0.599			0.016
Male	70 (56.45)	3 (60)		45 (48.39)	28 (77.78)		34 (64.15)	39 (51.32)
Female	54 (43.55)	2 (40)		48 (51.61)	8 (22.22)		19 (35.85)	37 (48.68)
Death			0.850			0.640			0.204
Yes	72 (58.06)	2 (40)		54 (58.06)	20 (55.56)		32 (60.38)	42 (55.26)
No	52 (41.94)	3 (60)		39 (41.94)	16 (44.44)		21 (39.62)	34 (44.74)
Transplanted			0.029			0.000			0.642
No	106 (85.48)	5 (100)		82 (88.17)	29 (80.56)		46 (86.79)	65 (85.53)
Yes	18 (14.52)	0 (0)		11 (11.83)	7 (19.44)		7 (13.21)	11 (14.47)
Cirrhosis etiology			0.002			0.539			0.346
Alcohol	30 (24.19)	1 (20)		21 (22.58)	10 (27.78)		12 (22.64)	19 (25)
Autoimmune	4 (3.23)	1 (20)		5 (5.38)	0 (0)		2 (3.77)	3 (3.95)
Cryptogenic-NASH	4 (3.23)	1 (20)		5 (5.38)	0 (0)		5 (9.43)	0 (0)
Virus C + alcohol	12 (9.68)	2 (40)		11 (11.83)	3 (8.33)		5 (9.43)	9 (11.84)
Virus B + C + alcohol	12 (9.68)	0 (0)		7 (7.53)	5 (13.89)		6 (11.32)	6 (7.89)
Virus B + alcohol	1 (0.81)	0 (0)		0 (0)	1 (2.78)		0 (0)	1 (1.32)
Virus C	1 (0.81)	0 (0)		1 (1.08)	0 (0)		1 (1.89)	0 (0)
Virus B	56 (45.16)	0 (0)		41 (44.09)	15 (41.67)		22 (41.51)	34 (44.74)
Other	4 (3.23)	0 (0)		2 (2.15)	2 (5.56)		0 (0)	4 (5.26)
Ascites			0.009			0.000			0.295
Yes	73 (58.87)	1 (20)		51 (54.84)	23 (63.89)		33 (62.26)	41 (53.95)
No	50 (40.32)	4 (80)		41 (44.09)	13 (36.11)		19 (35.85)	35 (46.05)
Paracentesis			0.000			0.789			0.453
Yes	39 (31.45)	0 (0)		27 (29.03)	12 (33.33)		18 (33.96)	21 (27.63)
No	82 (66.13)	5 (100)		64 (68.82)	23 (63.89)		34 (64.15)	53 (69.74)
Esophageal varices			0.260			0.004			0.006
Yes	94 (75.81)	3 (60)		70 (75.27)	27 (75)		43 (81.13)	54 (71.05)
No	30 (24.19)	2 (40)		23 (24.73)	9 (25)		10 (18.87)	22 (28.95)
Varices bleeding			0.067			0.095			0.214
Yes	14 (11.29)	0 (0)		10 (10.75)	4 (11.11)		4 (7.55)	10 (13.16)
No	108 (87.1)	5 (100)		81 (87.1)	32 (88.89)		48 (90.57)	65 (85.53)
Encephalopathy			0.000			0.007			0.215
Yes	45 (36.29)	0 (0)		33 (35.48)	12 (33.33)		17 (32.08)	28 (36.84)
No	79 (63.71)	5 (100)		60 (64.52)	24 (66.67)		36 (67.92)	48 (63.16)
Encephalopathy level			0.001			0.256			0.555
0	79 (63.71)	5 (100)		60 (64.52)	24 (66.67)		36 (67.92)	48 (63.16)
1	18 (14.52)	0 (0)		13 (13.98)	5 (13.89)		6 (11.32)	12 (15.79)
2	18 (14.52)	0 (0)		13 (13.98)	5 (13.89)		8 (15.09)	10 (13.16)
3	8 (6.45)	0 (0)		6 (6.45)	2 (5.56)		3 (5.66)	5 (6.58)
4	1 (0.81)	0 (0)		1 (1.08)	0 (0)		0 (0)	1 (1.32)
Developed HCC			0.105			0.126			0
Yes	114 (91.94)	4 (80)		83 (89.25)	35 (97.22)		44 (83.02)	74 (97.37)
No	10 (8.06)	1 (20)		10 (10.75)	1 (2.78)		9 (16.98)	2 (2.63)
Continuous variables	SGA		P value	MAC		P value	Handgrip strength		P value
	1	2		1	2		1	2
	124 (96.12)	5 (3.88)		93 (72.09)	36 (27.91)		53 (41.09)	76 (58.91)
Age (yr)	56.924 ± 10.633	41.355 ± 16.836	0.262	56.966 ± 11.719	54.651 ± 9.903	0.360	55.802 ± 11.576	56.789 ± 11.119	0.735
Survival time (mo)	109.674 ± 73.255	141.327 ± 70.428	0.105	108.091 ± 74.661	118.159 ± 69.541	0.139	104.957 ± 72.813	116.397 ± 73.1	0.945
Survival time (yr)	9.014 ± 6.021	11.616 ± 5.789	0.105	8.884 ± 6.136	9.712 ± 5.716	0.139	8.627 ± 5.985	9.567 ± 6.008	0.945
Height (cm)	164.444 ± 9.069	164.3 ± 7.12	0.200	164.102 ± 9.222	165.306 ± 8.38	0.419	166.84 ± 8.149	162.947 ± 9.121	0.242
First assessment weight (kg)	74.963 ± 14.722	62.18 ± 6.82	0.106	73.43 ± 14.914	77.147 ± 13.947	0.950	78.138 ± 14.441	71.853 ± 14.499	0.412
Body mass index	27.706 ± 4.836	23.114 ± 2.845	0.250	27.212 ± 4.794	28.347 ± 4.965	0.823	27.921 ± 3.898	27.161 ± 5.399	0.076
Arm circumference (cm)	30.579 ± 4.286	26.8 ± 2.28	0.116	30.155 ± 4.439	30.966 ± 3.887	0.447	32.095 ± 3.427	29.123 ± 4.472	0.060
Hospital admissions	1.887 ± 2.483		0.027	1.634 ± 2.254	2.278 ± 2.914	0.054	1.792 ± 2.634	1.813 ± 2.364	0.351
Length of stay (d)	6.894 ± 9.123		0.019	6.843 ± 9.741	6.068 ± 7.011	0.411	6.396 ± 8.498	6.758 ± 9.515	0.925
MAC (cm/mm)	24.895 ± 3.232	22.202 ± 1.43	0.085	24.527 ± 3.377	25.472 ± 2.702	0.139	25.92 ± 3.176	24.011 ± 3.049	0.590
BIA-phase angle (°)	6.625 ± 3.007	6.49 ± 1.023	0.373	6.612 ± 2.802	6.641 ± 3.355	0.745	6.839 ± 2.923	6.471 ± 3.004	0.818
MELD	11.096 ± 4.607	8.41 ± 6.854	0.370	10.872 ± 4.954	11.294 ± 4.009	0.431	10.378 ± 4.136	11.353 ± 5.069	0.206

SGA: Subjective global assessment; MAC: Mid-arm muscle circumference; NASH: Nonalcoholic steatohepatitis; MELD: Model for end-stage liver disease; HCC: Hepatocellular carcinoma, BIA: Bioimpedance.

Table 4 Logistic regression

Variable	β	SE	Wald	Sig.	Exp (β)	95%CI		Odds ratio (%)
						Inferior	Superior
BMI	-0.078	0.043	3.312	0.069	0.925	0.85	1.006	-7.5
AC	-0.017	0.046	0.143	0.705	0.983	0.898	1.075	-1.7
MAC	-0.035	0.06	0.353	0.552	0.965	0.859	1.085	-3.5
Handgrip strength	-0.021	0.016	1.6	0.206	0.98	0.949	1.011	-2
SAG classification	0.731	0.931	0.617	0.432	2.077	0.335	12.875	107.7
Child–Pugh	-0.746	0.327	5.193	0.023	0.474	0.25	0.901	-52.6

CI: Confidence interval; BMI: Body mass index; AC: Arm circumference; MAC: Mid-arm muscle circumference; SAG: Subjective global assessment; Sig: Significance.