PMID- 30015698
OWN - NLM
STAT- In-Data-Review
LR  - 20190225
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 103
IP  - 3
DP  - 2019 Mar
TI  - Poor Cardiorespiratory Fitness Is a Risk Factor for Sepsis in Patients Awaiting
      Liver Transplantation.
PG  - 529-535
LID - 10.1097/TP.0000000000002360 [doi]
AB  - BACKGROUND: Patients with advanced liver disease are at increased risk of
      infection and other complications. A significant proportion of patients also have
      poor fitness and low muscle mass. The primary aim of this study was to
      investigate if cardiorespiratory fitness and body composition are risk factors
      for sepsis and other complications of advanced liver disease. METHODS: Patients
      being listed for liver transplantation underwent cardiopulmonary exercise testing
      to determine ventilatory threshold (VT). Computed tomography was used to measure 
      skeletal muscle and subcutaneous and visceral adipose tissue indexes. All
      unplanned hospital admissions, deaths or delistings before transplantation were
      recorded. RESULTS: Eighty-two patients (aged 55.1 [50.6-59.4] years, median
      (interquartile range); male 87%] achieved a median VT of 11.7 (9.7-13.4)
      mL.kg.min. Their median model of end-stage liver disease, incorporating serum
      sodium score was 18 (14-22); and 37 had hepatocellular carcinoma. There were 50
      admissions in 31 patients; with 16 admissions for sepsis in 13 patients. Patients
      with sepsis had a significantly lower VT (sepsis, 9.5 [7.8-11.9]; no sepsis, 11.8
      [10.5-13.8] mL.kg.min; P = 0.003]. No body composition variables correlated with 
      sepsis, nor were there any significant associations between VT and unplanned
      admissions for other indications. Multivariate logistic regression demonstrated
      that VT was independently associated with a diagnosis of sepsis (P = 0.03).
      Poisson regression revealed that VT was a significant predictor for the number of
      septic episodes (P = 0.02); independent of age, model of end-stage liver disease,
      incorporating serum sodium score, hepatocellular carcinoma diagnosis, presence of
      ascites, and beta-blocker use. CONCLUSIONS: Poor cardiorespiratory fitness is an 
      independent risk factor for the development of sepsis in advanced liver disease.
FAU - Wallen, Matthew P
AU  - Wallen MP
AD  - Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School
      of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane,
      Queensland, Australia.
FAU - Woodward, Aidan J
AU  - Woodward AJ
AD  - School of Medicine, The University of Queensland, Brisbane, Queensland,
      Australia.
AD  - Department of Gastroenterology and Hepatology, Princess Alexandra Hospital,
      Brisbane, Queensland, Australia.
FAU - Hall, Adrian
AU  - Hall A
AD  - Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland,
      Australia.
FAU - Skinner, Tina L
AU  - Skinner TL
AD  - Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School
      of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane,
      Queensland, Australia.
FAU - Coombes, Jeff S
AU  - Coombes JS
AD  - Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School
      of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane,
      Queensland, Australia.
FAU - Macdonald, Graeme A
AU  - Macdonald GA
AD  - School of Medicine, The University of Queensland, Brisbane, Queensland,
      Australia.
AD  - Department of Gastroenterology and Hepatology, Princess Alexandra Hospital,
      Brisbane, Queensland, Australia.
AD  - Translational Research Institute, Brisbane, Queensland, Australia.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
EDAT- 2018/07/18 06:00
MHDA- 2018/07/18 06:00
CRDT- 2018/07/18 06:00
PHST- 2018/07/18 06:00 [pubmed]
PHST- 2018/07/18 06:00 [medline]
PHST- 2018/07/18 06:00 [entrez]
AID - 10.1097/TP.0000000000002360 [doi]
PST - ppublish
SO  - Transplantation. 2019 Mar;103(3):529-535. doi: 10.1097/TP.0000000000002360.