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New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients.
Minerva Gastroenterol Dietol 2013; 59(2):173-86MG

Abstract

The natural history of cirrhotic patients is highly variable due to several factors including hepatic synthetic function, presence and degree of portal hypertension, the cause of cirrhosis, the possibility of resolution of the underlying damaging process, and the occurrence of liver cancer. Currently, D'Amico stage classification and Child-Pugh and Model for End-Stage Liver Disease (MELD) scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of evaluation of the nutritional and functional status. Most widely recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma; however, sarcopenia or severe muscle wasting is one of the most common and frequently hidden complications which negatively impact survival, quality of life, and response to stressor, such as infection and surgery. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis, and also analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in cirrhosis and their impact after liver transplantation. We also discuss existing and potential novel therapeutic strategies for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in cirrhosis in an effort to improve survival and reduced morbidity related to cirrhosis. Finally, we propose that future studies including sarcopenia with the MELD score may allow better prediction of mortality among cirrhotic patients waiting for liver transplantation; however, due to the worldwide shortage of organs for transplants, one of the vital clinical questions is the feasibility to treat sarcopenia in cirrhosis without the need of liver transplant.

Authors+Show Affiliations

Division of Gastroenterology and Liver Unit University of Alberta HospitalEdmonton, Alberta, Canada - aldo.montanoloza@ualberta.ca.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23831908

Citation

Montano-Loza, A J.. "New Concepts in Liver Cirrhosis: Clinical Significance of Sarcopenia in Cirrhotic Patients." Minerva Gastroenterologica E Dietologica, vol. 59, no. 2, 2013, pp. 173-86.
Montano-Loza AJ. New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients. Minerva Gastroenterol Dietol. 2013;59(2):173-86.
Montano-Loza, A. J. (2013). New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients. Minerva Gastroenterologica E Dietologica, 59(2), pp. 173-86.
Montano-Loza AJ. New Concepts in Liver Cirrhosis: Clinical Significance of Sarcopenia in Cirrhotic Patients. Minerva Gastroenterol Dietol. 2013;59(2):173-86. PubMed PMID: 23831908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients. A1 - Montano-Loza,A J, PY - 2013/7/9/entrez PY - 2013/7/9/pubmed PY - 2013/12/20/medline SP - 173 EP - 86 JF - Minerva gastroenterologica e dietologica JO - Minerva Gastroenterol Dietol VL - 59 IS - 2 N2 - The natural history of cirrhotic patients is highly variable due to several factors including hepatic synthetic function, presence and degree of portal hypertension, the cause of cirrhosis, the possibility of resolution of the underlying damaging process, and the occurrence of liver cancer. Currently, D'Amico stage classification and Child-Pugh and Model for End-Stage Liver Disease (MELD) scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of evaluation of the nutritional and functional status. Most widely recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma; however, sarcopenia or severe muscle wasting is one of the most common and frequently hidden complications which negatively impact survival, quality of life, and response to stressor, such as infection and surgery. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis, and also analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in cirrhosis and their impact after liver transplantation. We also discuss existing and potential novel therapeutic strategies for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in cirrhosis in an effort to improve survival and reduced morbidity related to cirrhosis. Finally, we propose that future studies including sarcopenia with the MELD score may allow better prediction of mortality among cirrhotic patients waiting for liver transplantation; however, due to the worldwide shortage of organs for transplants, one of the vital clinical questions is the feasibility to treat sarcopenia in cirrhosis without the need of liver transplant. SN - 1121-421X UR - https://www.unboundmedicine.com/medline/citation/23831908/New_concepts_in_liver_cirrhosis:_clinical_significance_of_sarcopenia_in_cirrhotic_patients_ L2 - http://www.minervamedica.it/index2.t?show=R08Y2013N02A0173 DB - PRIME DP - Unbound Medicine ER -