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

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

World J Clin Cases. 2021 Dec 16;9(35):10871-10883. doi: 10.12998/wjcc.v9.i35.10871.

Authors

Xing Dai¹, Ben Gao¹, Xin-Xin Zhang², Jiang Li³, Wen-Tao Jiang⁴

Affiliations

¹ Department of Liver Transplant, The First Central College of Tianjin Medical University, Tianjin 300110, China.
² Department of Endocrinology, Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin 300134, China.
³ Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300110, China. lijiang_009@163.com.
⁴ Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300110, China.

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