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
Abstract
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, there is no recommended standard for the nutrition assessment of patients waiting for LT, and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.

AIM

The study aim was to investigate the value of the controlling nutritional status (CONUT) score and psoas muscle thickness per height (PMTH) in predicting prognosis in LT.

METHODS

We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University. The CONUT score is derived from the preoperative serum albumin and total cholesterol levels, and total lymphocyte count. Patients were divided into low (≤ 4), medium (5–8), and high (9–12) CONUT score groups perioperative characteristics, Clavien-Dindo grade III/IV/V postoperative complications, graft loss and infection, and cumulative postoperative survival in the three groups were compared 3 mo after LT. PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient. The cutoff values of receiver operating characteristic curves were determined separately for men and women. The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men. The patients were then divided into low and high PMTH groups by the cutoff values. The comparison of data between the two groups was the same as above.

RESULTS

Patients with medium and high CONUT scores had lower preoperative serum hemoglobin, more intraoperative red blood cell (RBC) transfusions, longer postoperative intensive care unit stay and hospital stays, higher 7 and 14 preoperative-day serum bilirubin levels, and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores. Differences in the 3-mo cumulative survival among the three groups were not significant. Patients with a low PMTH had higher preoperative serum urea nitrogen, more intraoperative packed RBC and frozen plasma transfusions, longer times to postoperative ventilator extubation, higher incidence of total postoperative complications, and a lower 3-mo cumulative survival than those with a high PMTH.

CONCLUSION

A CONUT score ≥ 5 and a low PMTH were both associated with poor prognosis in LT. The CONUT score had no predictive value for short-term patient survival after LT, but the PMTH was predictive of short-term patient survival after LT.

Keywords: Liver transplantation, Controlling nutritional status score, Psoas muscle thickness per height, Nutrition assessment, Complications, Prognosis

Core Tip: This retrospective study analyzed the short-term prognosis after liver transplantation (LT) using two nutrition assessment tools, the controlling nutritional status score and psoas muscle thickness per height. Both had predictive value for prognosis in LT.