Abstract
Purpose: This study aimed at assessment of respiratory muscle performance (RMP), functional capacity (FC), feeling of fatigue, and quality of life (QOL) in liver transplant candidates and to correlate these variables with each other and with the Model for End-Stage Liver Disease (MELD). Methods: A prospective study carried out from January/2008 to June/2009 including 130 liver transplant candidates on waiting–list at the São Paulo Health Transplant System, followed at the Unit of Liver Transplantation - Unicamp with cirrhosis of any etiology, independent of gender, age, and degree of liver function impairment as classified by the MELD score. Respiratory muscle performance was determined by respiratory muscle strength (RMS - PIMAX and PEMAX), vital capacity (VC), and FC measured during six-minute walk tests (6MWT). Fatigue was evaluated using the Fatigue Severity Scale (FSS), and QOL was assessed using the SF-36 questionnaire. Results: Expressed as the mean SD and percentage of the predicted value: MELD=16+4, VC=4.0+0.9L - (97%+16%), PIMAX=77+28cmH2O -(71+25%), PEMAX=76+26cmH2O (76+26%), 6MWT=453.9+81.2m (73+13%), FSS=34+17, and compromised QOL, particularly in physical (48+41) and emotional (57+41) aspects, vitality (58+26) and general state (58+24). Predicted VC was negatively correlated with MELD (p=0.0034) and positively correlated with RMS and 6MWT (p=0.0217). Greater distances in the 6MWT were associated with a higher RMS and QOL and less fatigue. Greater FSS scores resulted in lower QOL scores. Conclusion: A decrease in VC was related to the severity of liver disease and a decrease in RMS and FC, which, in turn, correlated with greater fatigue and lower QOL.
Highlights
Patients with cirrhosis often experience loss of muscle mass and significant weakness related to the degree of organ function impairment.[1,2] In the terminal stage of liver failure, patients may be significantly restricted in their daily activities, primarily due to fatigue.[3,4,5] Until the late 1990s, the Child-Turcotte Pugh (CTP) classification was the prevailing model to evaluate chronic liver disease and determine whether a patient was a candidate for a liver transplant.[4,5] In 2000, the Model for End-Stage Liver Disease (MELD)[6] was adopted to predict survival
Half the candidates (54.4%) had a diagnosis of viral hepatitis C (VHC), associated or not to alcoholism, and alcohol consumption was the sole cause for cirrhosis in 23% of candidates
The results showed a high incidence of complications of cirrhosis
Summary
Patients with cirrhosis often experience loss of muscle mass and significant weakness related to the degree of organ function impairment.[1,2] In the terminal stage of liver failure, patients may be significantly restricted in their daily activities, primarily due to fatigue.[3,4,5] Until the late 1990s, the Child-Turcotte Pugh (CTP) classification was the prevailing model to evaluate chronic liver disease and determine whether a patient was a candidate for a liver transplant.[4,5] In 2000, the Model for End-Stage Liver Disease (MELD)[6] was adopted to predict survival. In Brazil, the MELD criteria are used to order wait-listed candidates since 2006, as implemented by the Ministerial Directive 1160/GM.[7]
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