The Significance of Energetic Metabolism Investigation, Body Composition
and Liver Disease Progress Parameters for Short Term Mortality Prediction and for Estimation
of Hospital Resources Utilisation
Trunečka P.1, Ryska M.2, Kieslichová E.3, Wohl P.4, Lánská V.5, Wohl P.1, Krasničanová H.6, Böhmová R.7, Stříž I.7, Filip K.5, Špičák J.1
Klinika hepatogastroenterologie, Transplantační centrum IKEM 2Klinika transplantační chirurgie, Transplantační centrum IKEM 3Klinika anesteziologie, resuscitace a intenzivní péče, Transplantační centrum IKEM 4Klinika diabetologie, Centrum diabetologie IKEM 6Dětská klinika 2. LF UK 7Imunologické pracoviště, Transplantační centrum IKEM 5Institut klinické a experimentální medicíny |
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Summary:
The aim: The aim of this prospective study was identification of factors predicting the results of liver transplantation
for survival and hospital resources utilisation.
Material and methods: In a prospective study 69 patients had liver transplantation from a group of 104
patients suffering from chronic liver disease evaluated in IKEM during 2001–2003. Post-transplantation follow-up time was 6 months minimally. Seven recipients died during this period. Energetic metabolism and
substrate utilisation by indirect calorimetry, human body composition by anthropometry and DEXA method
were investigated. Basic biochemical, hematological and clinical investigation were carried out and Child-
Pugh score and MELD (Model for end-stage-liver disease) score calculated. IL-6 and HGF (hepatocyte growth
factor) plasma concentration were measured. Number connection test and clearance of indocyanine green
were carried out. Univariate and multivariate analysis of relationship variables characterised the state of
recipient before transplantation to mortality and hospital resources utilisation measure was carried out.
Results: Predictive factors for unfavourable outcome were high age, low albumin and high urea concentration.
High BMI, MELD and Child-Pugh score were predictive factors for higher hospital resources utilisation.
Indocyanin green retention correlated significantly to Child-Pugh and MELD score. Low plasmatic concentration
of IL-6 was predictive factor for unfavourable outcome of transplantation. Hypermetabolism expressed es
more than 20% difference between measured and expected resting energy expenditure was not a predictive
for unfavourable outcome of transplantation as well as any measurement of body composition. BMI was
significantly higher in a group of patients with higher resources utilisation.
Conclusions: Child-Pugh score, MELD score and function liver test by indocyanine green proved approximately
the same value in prediction of transplantationoutcome. Detailed investigations of energetic metabolism
and body composition were not important for prognosis. IL-6 and HGF plasma concentration were important
predictive factors for mortality and increased hospital resources utilisation.
Key words:
liver transplantation – mortality – hospital resources utilisation – indocyanine green – IL-6 – HGF
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