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
Abstract
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 transplantation outcome.
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.