Nutritional Status Evaluation In Patients With Liver Cirrhosis And The Analysis Of Risk Factors Associated With Sarcopenia

Objective:To assess the nutritional status of patients with liver cirrhosis in using different nutrition assessment methods,comparing the nutritional assessment status of L3-SMI and traditional nutrition evaluation methods to patients with liver cirrhosis,and to further analyze the risk factors related to sarcopenia to provide a theoretical basis for the diagnosis of malnutrition in patients with liver cirrhosis.Methods:We analyzed 106 patients who were diagnosed with liver cirrhosis in the Second Affiliated Hospital of Kunming Medical University from January 2019 to December 2019,and were divided into A,B,and C groups based on Child-Pugh scores of A,B,and C,using anthropometrics(BMI,TSF,AMC),laboratory indicators(albumin),Subjective Global Assessment(SGA),Nutritional Risk Screening(NRS-2002),and L3 skeletal muscle index(L3-SMI)to assess the incidence of malnutrition,examining the nutritional status of patients of three groups,and comparing the incidence of malnutrition in patients with liver cirrhosis between L3-SMI and traditional nutrition assessment.At the same time,106 patients were divided into sarcopenia group and non-sarcopenia group according to whether complicated with sarcopenia,and we compared the two groups of patients with the general information(gender,age,etiology),Nutrition parameter index(BMI,TSF,AC,AMC),laboratory indicators(blood routine,biochemical indicators,coagulation Function),the severity of liver function,and the incidence of complications,and further stepwise binary logistic regression analysis was used to finally confirm the risk factors of sarcopenia in patients with liver cirrhosis.Results:1.A total of 106 patients were included in this study,the incidence of malnutrition assessed by BMI,TSF,AMC,albumin,SGA,NRS-2002,and L3-SMI was respectively 9.4%,50.9%,51.9%,75.5%,36.8%,33.0%,and 68.9%.There was a statistically significant difference in the incidence of malnutrition among the three groups of patients by using albumin to assess nutritional status(P<0.001),and a further comparison showed that the incidence of malnutrition rate in Child B was higher than A,and C was higher than B.The use of SGA to evaluate the difference in the incidence of malnutrition among the three groups was statistically significant(P=0.001).Further comparison showed that the incidence rate of the mild and moderate/severity malnutrition in Child C group was higher than Child A group.There were no significant differences in the incidence of malnutrition among other nutritional assessment methods in Child A,B,and C groups(P>0.05);Chi-square test showed that the detection rate of malnutrition in patients with liver cirrhosis by using L3-SMI was higher than other nutrition evaluation methods(P<0.05).2.A total of 73 patients with liver cirrhosis were found to have sarcopenia,the incidence was 68.9%.The mean age was 57.84 years old and the mean Child-Pugh scores was 8.86,which were significantly higher than the non-sarcopenia group(57.84±10.77 vs 51.39±9.01,8.86±2.81vs7.69±2.24,P<0.05).There were 49 cases of male(67.1%),23 cases of alcoholic cirrhosis(31.5%),36 cases who were evaluated by SGA as mild or moderate malnutrition(49.3%),33 cases who were assessed as nutritional risk by NRS-2002(45.2%),26 cases who complicated with infection(35.6%),and 23 cases who complicated with large ascites,which were significantly greater than those in the non-sarcopenia group(P<0.05).Besides,compared with non-sarcopenia group,BMI,TSF,AC,AMC,L3-SMA,L3-SMI,hemoglobin levels were lower in the sarcopenia group[(21.86±3.33)kg/m2 vs(25.57±3.83)kg/m2,12.61±4.30)mm vs(16.46±5.21)mm,(24.06±3.40)cm vs(27.44±3.16)cm,(20.10±2.72)cm vs(22.27±2.41)cm,(106.20±26.18)cm2 vs(133.31±29.46)cm2,(38.71±7.72)cm2/m2 vs(50.37±8.30)cm2/m2,(105.37 ±29.83)g/L vs(118.76±29.22)g/L,and the P values are all<0.05].3.Multivariate logistic regression analysis was performed on variables with statistically significant differences in the comparison between groups.The results showed that female(OR=0.181,95%CI:0.044-0.74),BMI(OR=0.577,95%CI:0.505-0.906)were independent protective factors of sarcopenia in patients with liver cirrhosis;Assessed as nutritional risk by NRS-2002(OR=6.463,95%CI:1.014～41.209),infection(OR=1.129,95%CI:1.030～1.236),and large ascites(OR=5,95%CI:1.273~19.632)were independent risk factors of sarcopenia in patients with liver cirrhosis.Conclusion:1.The incidence of malnutrition in patients with cirrhosis is high and is related to the severity of liver cirrhosis.2.L3-SMI can objectively and accurately assess muscle mass,and is superior to traditional nutrition evaluation methods in nutrition evaluation of patients with liver cirrhosis.3.The incidence of sarcopenia in patients with liver cirrhosis is 68.9%.Elderly,male and alcoholic liver cirrhosis patients are more likely to have sarcopenia.In comparison with patients without sarcopenia,the sarcopenia patients have worse nutrition status and liver function,and are more prevalent in complication with infection and ascites.4.Female and increased BMI are independent protective factors of sarcopenia in patients with liver cirrhosis;Age,NRS-2002 score greater than or equal to 3 points,complicated with infection and large ascites are independent risk factors of sarcopenia in patients with liver cirrhosis.