2020年修订的JSGE/JSH肝硬化患者管理指南推荐了新的营养评估和干预策略,尽管它们在日常临床实践中的有用性尚不清楚。
共有769例肝硬化患者被分类为低,中介-,根据低蛋白血症和肌肉减少症的高危人群,指南中为启动营养治疗算法建立的标准。使用Cox比例风险模型分析这些组与死亡率之间的关联。使用倾向评分匹配评估支链氨基酸(BCAAs)对存活的影响。
在登记的病人中,495(64%)为男性,中位年龄为73岁,428(56%)有低蛋白血症,156人(20%)患有肌少症,288人(37%)接受BCAA。在1.5年的中位随访期间,276例(36%)患者逝世亡。中等风险[危险比(HR),1.60;95%置信区间(CI),1.18-2.18]和高风险(HR,2.85;95%CI,1.92-4.23)组独立预测死亡率。在倾向评分匹配的250名患者中,49例(39%)BCAA治疗死亡,58例(46%)未治疗死亡。BCAA治疗的患者的总生存率高于未治疗的患者(HR,0.67;95%CI,0.46-0.98)。BCAA的生存益处在中等风险(HR,0.50;95%CI,0.31-0.80)和高风险(HR,0.38;95%CI,0.16-0.91)组。
2020JSGE/JSH肝硬化指南有助于对死亡风险进行分层,并为营养不良的肝硬化患者提供有效的营养干预。
The JSGE/JSH
guidelines for the management of patients with liver cirrhosis revised in 2020 recommends new strategies for nutritional assessment and intervention, although their usefulness in daily clinical practice is unclear.
A total of 769 patients with cirrhosis were classified into low-, intermediate-, and high-risk groups according to hypoalbuminemia and sarcopenia, the criteria established for initiating the nutritional therapy algorithm in the
guidelines. The association between these groups and mortality was analyzed using a Cox proportional hazards model. The effect of branched-chain amino acids (BCAAs) on survival was evaluated using propensity score matching.
Of the enrolled patients, 495 (64%) were men with a median age of 73 years, 428 (56%) had hypoalbuminemia, 156 (20%) had sarcopenia, and 288 (37%) were receiving BCAAs. During a median follow-up period of 1.5 years, 276 (36%) patients died. The intermediate-risk [hazard ratio (HR), 1.60; 95% confidence interval (CI), 1.18-2.18] and high-risk (HR, 2.85; 95% CI, 1.92-4.23) groups independently predicted mortality. Among the propensity score-matched 250 patients, 49 (39%) BCAA-treated and 58 (46%) untreated died. Overall survival was higher in BCAA-treated patients than in untreated patients (HR, 0.67; 95% CI, 0.46-0.98). The survival benefit of BCAAs was pronounced in the intermediate-risk (HR, 0.50; 95% CI, 0.31-0.80) and high-risk (HR, 0.38; 95% CI, 0.16-0.91) groups.
The 2020 JSGE/JSH
guidelines for liver cirrhosis are useful in stratifying the mortality risk and providing effective nutritional interventions for malnourished patients with cirrhosis.