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Asociación de sarcopenia con complicaciones y mortalidad en pacientes cirróticos en lista de espera para trasplante hepático

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dc.contributor.advisorHernández Cely, Geovanny
dc.creatorDíaz Nassif, Gustavo Andrés
dc.creator.degreeEspecialista en Hepatología
dc.creator.degreeLevelEspecialización
dc.date.accessioned2025-01-29T16:45:32Z
dc.date.available2025-01-29T16:45:32Z
dc.date.created2024-10-30
dc.descriptionIntroducción: La sarcopenia, caracterizada como la pérdida de masa y fuerza muscular, es un predictor independiente de mortalidad en pacientes con enfermedad hepática crónica, tanto antes como después del trasplante hepático. La medición de la fuerza muscular con dinamómetro puede servir como un marcador de fragilidad en estos pacientes. Objetivo: Evaluar la relación entre sarcopenia y la aparición de complicaciones y la mortalidad en pacientes con cirrosis que están en lista de espera para trasplante hepático en la Fundación Cardio Infantil. Metodología: Se realizó un estudio de cohorte retrospectivo incluyendo pacientes mayores de 18 años en lista de espera para trasplante hepático entre 2020 y 2022. La sarcopenia se clasificó usando la escala SARCF. Se empleó un modelo de regresión logística binaria para calcular los Odds Ratio (OR) ajustados, considerando la presencia de sarcopenia, complicaciones y mortalidad como variables dependientes. Resultados: Se incluyeron 243 pacientes, de los cuales el 36,21% presentó sarcopenia. Se observó un alto riesgo nutricional en el 39,09% de los casos. Los hombres tenían 12 veces la probabilidad de tener sarcopenia (OR 12,05; IC 95% 3,11-46,59) y los pacientes con osteoporosis 5,39 veces (OR 5,39; IC 95% 1,36-21,25). Un aumento de una unidad en la dinamometría reducía la probabilidad de sarcopenia en 0,72 (OR 0,72; IC 95% 0,64-0,82). No se encontraron diferencias significativas en complicaciones según la sarcopenia (p=0,43). Factores predictivos de complicaciones incluyeron edad (OR 1,02; IC 95% 1,01-1,06), sexo masculino (OR 6,08; IC 95% 1,71-21,53), y el puntaje en la escala CHILD (OR 1,41; IC 95% 1,12-1,77). Los pacientes con sarcopenia presentaron una mayor mortalidad (36,4% vs. 17,4%, p=0,001). El aumento en un punto de la escala MELD incrementa la probabilidad de muerte en 1,11 veces; la necesidad de UCI aumenta la probabilidad en 3,41 y la trombosis en 2,48. Discusión: La sarcopenia está asociada con el sexo, osteoporosis y la fuerza muscular medida por dinamometría. Las complicaciones están relacionadas con la edad, el sexo y el puntaje CHILD, mientras que la mortalidad se relaciona con la edad, el puntaje MELD, la necesidad de UCI y la trombosis. La intervención temprana en sarcopenia puede mejorar la supervivencia y reducir los costos de salud.
dc.description.abstractIntroduction: Sarcopenia, characterized as the loss of muscle mass and strength, is an independent predictor of mortality in patients with chronic liver disease, both before and after liver transplantation. Measurement of muscle strength with a dynamometer can serve as a marker of frailty in these patients. Objective: To evaluate the relationship between sarcopenia and the appearance of complications and mortality in patients with cirrhosis who are on the waiting list for liver transplant at the Cardio Infantil Foundation. Methodology: A retrospective cohort study was conducted including patients over 18 years of age on the waiting list for liver transplant between 2020 and 2022. Sarcopenia was classified using the SARCF scale. A binary logistic regression model was used to calculate the adjusted Odds Ratio (OR), considering the presence of sarcopenia, complications and mortality as dependent variables. Results: 243 patients were included, of which 36.21% presented sarcopenia. A high nutritional risk was observed in 39.09% of cases. Men were 12 times more likely to have sarcopenia (OR 12.05; 95% CI 3.11-46.59) and patients with osteoporosis were 5.39 times more likely (OR 5.39; 95% CI 1.36-21). ,25). An increase of one unit in dynamometry reduced the probability of sarcopenia by 0.72 (OR 0.72; 95% CI 0.64-0.82). No significant differences were found in complications according to sarcopenia (p=0.43). Predictive factors for complications included age (OR 1.02; 95% CI 1.01-1.06), male sex (OR 6.08; 95% CI 1.71-21.53), and the scale score. CHILD (OR 1.41; 95% CI 1.12-1.77). Patients with sarcopenia had a higher mortality (36.4% vs. 17.4%, p=0.001). An increase in one point on the MELD scale increases the probability of death by 1.11 times; the need for ICU increases the probability by 3.41 and thrombosis by 2.48. Discussion: Sarcopenia is associated with sex, osteoporosis and muscle strength measured by dynamometry. Complications are related to age, sex, and CHILD score, while mortality is related to age, MELD score, need for ICU, and thrombosis. Early intervention in sarcopenia can improve survival and reduce healthcare costs.
dc.format.extent50 pp
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dc.identifier.doihttps://doi.org/10.48713/10336_44889
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/44889
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Hepatología
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectSarcopenia
dc.subjectCirrosis hepática
dc.subjectFactores de riesgo
dc.subjectEnvejecimiento
dc.subjectTrasplante de hígado
dc.subject.keywordSarcopenia
dc.subject.keywordLiver Cirrhosis
dc.subject.keywordRisk factors
dc.subject.keywordAging
dc.subject.keywordLiver transplant
dc.titleAsociación de sarcopenia con complicaciones y mortalidad en pacientes cirróticos en lista de espera para trasplante hepático
dc.title.TranslatedTitleAssociation of sarcopenia with complications and mortality in cirrhotic patients on the waiting list for liver transplantation.
dc.title.alternativeSarcopenia y riesgo de mortalidad en cirroticos que seran trasplantados
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dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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