The influence of bacterial translocation and systemic inflammation on the nutrition, skeletal muscles, and survival of patients with liver cirrhosis

Abstract

Annotation. Malnutrition and sarcopenia are common prognosis-modifying complications of liver cirrhosis (LC). Bacterial translocation and systemic inflammation may be involved in the development of nutritional and muscle insufficiency in LC. The aim of the study was to assess the relationship between serum markers of bacterial translocation and systemic inflammation with nutrition, skeletal muscle, and survival in patients with decompensated LC. 74 patients (age 55.3±11.4 years) were included in the study. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Skeletal muscle mass was assessed using the Skeletal Muscle Index (SMI), and muscle strength was assessed by handgrip strength. The level of lipopolysaccharide-binding protein (LBP), interleukin-6 (Interleukin-6, IL-6), and C-reactive protein (C Reactive Protein, CRP) in blood serum was determined by enzyme immunoassay (ELISA). Statistical data processing was performed in SPSS22. It was found that serum LBP, IL-6, and CRP levels moderately correlated with PG-SGA (r= 0.549, 0.434, and 0.453, respectively, p˂0.005), SMI (r= -0.517, -0.518, and -0.468, respectively, p˂0.005), and handgrip strength (r= -0.338, -0.427, and -0.423, respectively, p˂0.005), and predicted severe malnutrition (AUC (LBP) = 0.746; AUC (IL-6) = 0.672; AUC (CRP) = 0.745, p˂0.05) and sarcopenia (AUC (LBP) = 0.861; AUC (IL-6) = 0.789; AUC (CRP) = 0.744, p˂0.01). 42 patients died from LC complications during the follow-up (Me 367 (82-569) days). In the Kaplan-Meier analysis, the mortality of patients with high levels of LBP (more than 33.4 pg/ml), IL-6 (more than 7.68 pg/ml), and CRP (more than 5.52 mg/l) were significantly higher than that of patients with conditionally low levels. Further studies are needed to determine whether correction of bacterial translocation and systemic inflammation can improve nutritional, skeletal muscle status, and survival in patients with decompensated LC.