الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Liver is the central organ in nutrient metabolism and has many important metabolic functions, thus in patients with liver cirrhosis, these metabolic functions are impaired resulting in a variety of nutritional disorders, such as protein-energy-malnutrition or muscle abnormalities. Among a wide variety of muscle abnormalities in patients with liver cirrhosis, sarcopenia is described as the most common form. Indeed, sarcopenia is prevalent in 30–70% of cirrhotic patients with a higher prevalence in men (61.6%) than in woman (36%). So far, there is no gold standard for the diagnoses of sarcopenia in liver cirrhosis patients. General criteria for the diagnosis of sarcopenia are not universally accepted and several different definitions coexist. Sarcopenia is defined as the generalized loss of skeletal muscles mass, strength, and function. It is reported in approximately 50% of patients with cirrhosis awaiting liver transplantation, with a relatively higher prevalence in male compared to female candidates. Cirrhosis is a leading cause of mortality worldwide, and it is associated with a significant reduction in health-related quality of life. The ultimate therapy for liver cirrhosis is liver transplantation. Predicting the evolution of liver cirrhosis to improve therapeutic decision is a challenge, especially for patients who can obtain a donor liver because it is resource spending. Therefore, prognostic factors that can be used to determine survival without liver transplantation are required. Recent evidence suggests that, in patients with cirrhosis, sarcopenia is independently correlated with increased risks of liver decompensating and mortality, both before and after transplantation. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, shown to be prevalent in adults with cancer and common chronic comorbidities such as liver cirrhosis, advanced heart failure, renal failure, malignancies, connective tissue diseases, myopathies and endocrinopathies. In such patients, sarcopenia reflects protein–energy malnutrition, and is considered an important method to assess the nutritional status of the patient because of its quantitative, objective and simple methods. Moreover, it has emerged as an independent predictor of poor prognosis in a variety of clinical conditions. Several studies have reported that sarcopenia was associated with worse prognosis, as well as reduced survival, after liver transplantation. Sarcopenia seems to be the result of complex interactions involving inadequate nutrition, impaired synthesis of glycogen, underlying hyper metabolism, and impairment of skeletal muscle protein synthesis due to Porto systemic shunting in cirrhotic liver. The aim of this study was to assess the impact of sarcopenia on Morbidity (Hepatic Encephalopathy, SBP, Variceal Bleeding and Ascites) and Morbidity of cirrhotic patients. This cohort study was carried on 127 patients known to have liver cirrhosis presented to hepatology unit in Specialized Medical Hospital and Gastro-entrology Surgical Center in aperiod of one year from October 2019 to October 2020, and were classified according to L3-PMI using abdominal CT into two groups: Cirrhotic patients with sarcopenia and Cirrhotic patients without sarcopenia, Ptients were followed up for six months. The main findings of the study revealed that: The prevelance of Sarcopenia among patients with liver cirrhosis was (41.7%) 53 out of 127 cirrhotic patients. There is no statistically significant difference between both groups regarding demographic (age, sex and smoking) and history of systemic diseases such as DM and Hypertension or HCC. Post Hepatitis C was the most frequent cause of liver cirrhosis, 116 cases (91%), followed by Budd Chiari 6 cases (4.7%), Autoimmune liver disase 3 cases (2.3%) and finally Hepatitis B 2 cases (1.5%), and there was no significant difference between both groups regarding the etiology of liver cirrhosis. Regarding laboratory data of studied cases, no significant difference was detected between both groups. Regarding radiological assessment of studied groups, there was no statistically significant difference. More than one half of cirrhotic patients without sarcopenia had compensated cirrhosis (Child score A) (58.1%), in the group of patients with sarcopenia only (47.2%) had Child score A and the majority of patients were decompansated with child score B and C. The mean MELD and MELD-Na score in sarcopenic group are slightly higher than non sarcopenic group with no difference between them. Ascites, SBP, Hepatic Encephalopathy, Variceal Bleeding and Mortality was statistically significant higher in group of patients with sarcopenia compared with patients without Sarcopenia. 15 cases (28.3%) in the group of cirrhotic patients with sarcopenia and 3 cases (4.1%) in the group of cirrhotic patients without sarcopenia died. There was statistically significant negative correlation between L3-PMI, as an indicator for sarcopenia, with Ascites, SBP, Hepatic Encephalopathy, and Mortality.