Relações entre qualidade de vida com gravidade da doença, estado nutricional, fragilidade e sarcopenia em pessoas com doença hepática crônica avançada

Abstract

INTRODUCTION: Advanced chronic liver disease (ACLD) represents an important public health problem. It can evolve with various clinical complications, which bring harm not only economically, but also to the health-related quality of life (HRQOL) of patients and their families. Clinically, they can develop malnutrition, sarcopenia and frailty, conditions that are very common in this population and that can occur in isolation or overlapping. The evaluation and management of these patients needs to go beyond the clinical treatment of already established complications. OBJECTIVE: To investigate the relationship between HRQoL, severity of liver disease, nutritional status, frailty and sarcopenia in cirrhotic patients. METHODS: In this cross-sectional study, patients with liver cirrhosis (18-70 years old) from a University Hospital in Maceió/AL (Brazil) were included. Sociodemographic and clinical data were collected. To assess HRQoL, the Chronic Liver Disease Questionnaire (CLDQ) and Short Form Health Survey – 36 (SF 36) were used. DHCA was classified according to its severity as CHILD A, B or C; and their position on the liver transplant waiting list according to the Model for End-stage Liver Disease sodium (MELD-Na) and MELD 3.0. Nutritional status included the collection of conventional anthropometry, nutritional screening using the Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT), and the Royal Free Hospital – Global Assessment (RFH-GA) tool was used to diagnose malnutrition. Body composition was measured using Dual-energy X-ray absorptiometry (DEXA), while functional capacity was identified by measuring handgrip strength using dynamometry. Frailty was also assessed using the liver fragility index (IFH). Sarcopenia was defined based on appendicular skeletal muscle mass (MMEA) and MMEA index obtained by DXA, associated with the sit-to-stand test and handgrip strength. Statistical analysis included multiple linear regression adjusted for sex, age and etiology of liver disease (SPSS v.26). RESULTS: 50 individuals with cirrhosis were evaluated. Of these, the average age was 48 ± 14 years, with a predominance (n = 36; 72%) of males, with alcohol intake (n = 26, 52%) being the main etiology of liver disease. (describe sex and age). When the analyzes were carried out, it was observed that the CLDQ was related to the severity of liver disease, but not to nutritional status. Hepatic decompensation (Child-Pugh B and C) was significantly related to CLQD, with the "concern" domain being the most related to disease severity assessment instruments. In decompensated participants there was significant impairment in the domains “fatigue”, “activity”, “worry” and in the “total score” of the questionnaire. When analyzing the SF-36 with the severity of the disease, we observed a relationship between Child-pugh and MELD 3.0 with “social aspects” and MELD-Na with “general health status”. The SF-36 demonstrated a close correlation with nutritional status, especially malnutrition, highlighting the item "social aspects" related to the severity of the disease (Child-Pugh and MELD 3.0), sarcopenia and malnutrition. The malnourished participants were compromised due to “limitations due to physical appearance” and “mental health”. Those with nutritional risk have a worse “general health status”. Malnutrition significantly decreased health-related quality of life in patients with cirrhosis, as indicated by reductions in “physical limitation” (β: -25.17, CI [-50.17, 0.16], p=0.04), “social aspects” (β: -23.91, CI [-39.54, -8.29], p=0.004) and “mental health” (β: -13.17, CI [-26.70, -0.81], p=0.03) domains of the SF-36 questionnaire. This analysis highlights the inherent link between physical limitations and malnutrition, revealing that being malnourished reduces the self-perceived physical well-being of cirrhotic individuals by 20 points. Likewise, reflecting the impact of cirrhosis severity, the “social aspects” domain was the HRQoL component correlated with two indicators of nutritional/functional status (β: -14.47, CI [-24.38, -4. 60], p<0.01). An important finding emphasizes the association between malnutrition and mental health, demonstrating that malnourished individuals with cirrhosis experience a reduction of more than 13 points in their perception of their health. CONCLUSION: Concern for one's own health is directly linked to 12 worse liver clinical condition and malnutrition/sarcopenia impacts the HRQoL of cirrhotic patients, particularly the social aspect, emphasizing the need for adequate anagement to improve the clinical and nutritional prognosis of these individuals.