Fudeyasu K1, Kawae T1, Iwaki D1, Nakashima Y1, Nagao A2, Hiramatsu A3, Kimura H4
1Hiroshima University Hospital, Department of Clinical Practice and Support, Division of Rehabilitation, Hiroshima, Japan, 2Hiroshima University Hospital, Department of Dietary Management, Hiroshima, Japan, 3Hiroshima University, Graduate School of Biomedical & Health Sciences, Department of Gastroenterology and Metabolism, Hiroshima, Japan, 4Hiroshima University Hospital, Department of Rehabilitation Medicine, Hiroshima, Japan
Background: In recent years, studies have reported on the increase in the incidence of sarcopenia accompanying liver disease progression, but the factors influencing secondary sarcopenia due to liver disease have not been clarified.
Purpose: The purpose of this study was to investigate the influence of liver dysfunction on physical function in patients with chronic liver disease and clarify the factors that affect physical function across the board.
Methods: The subjects were 102 patients with chronic liver disease admitted to the Department of Gastroenterology and Metabolism, Hiroshima University Hospital. Liver function, which represents the degree of progression of liver disease, was categorized using the Child-Pugh classification (A/B/C), which includes Child-Pugh scores from 5 to 15 points based on five items (total bilirubin [T-Bil], prothrombin time [PT], albumin, ascites, and encephalopathy). All subjects in this study were Child-Pugh class A. The subject's basic data such as sex, age, and body mass index (BMI) were collected, and their appendicular skeletal muscle mass, grip strength, usual gait speed (which is a representative index for sarcopenia diagnosis), and single-leg standing time were measured to determine their physical function. Blood data (T-Bil, albumin, aspartate aminotransferase, alanine, platelet, hemoglobin levels and PT) at the beginning of hospitalization were collected from the medical records. The patients were classified into two groups of Child-Pugh scores 5 (Child 5; n=83, 33 female subjects) and 6 (Child 6; n=19, 8 female subjects), which comprise Child-Pugh classification A, and then compared using the Wilcoxon´s and chi-square tests. The factors associated with the physical function that showed a difference between the two groups were investigated using multiple regression analysis.
Results: There was no significant difference in sex, age(65.1±12.4 v.s.68.9±6.6), and BMI(26.1±4.7 v.s.26.1±7.1) between the Child 5 and 6 groups. Grip strength was significantly lower in the Child 6 group than in the Child 5 group. Prothrombin time and albumin and hemoglobin levels were significantly lower in the Child 6 group than in the Child 5 group. On multiple regression analysis with grip strength as the dependent variable and sex, age, BMI, PT, and albumin and hemoglobin levels as independent variables, the regression equation(R*2=0.635, p 0.001) revealed sex(β=-0.527, p 0.01), age(β=-0.383, p 0.01), and hemoglobin level(β=0.244, p 0.01) to be significant explanatory variables.
Conclusion(s): When mild liver dysfunction occurs in patients with chronic liver disease, they exhibit muscle weakness. It has been revealed that female sex, aging, and low hemoglobin levels are associated with muscle weakness in chronic liver disease.
Implications: In recent years, sarcopenia has been reported to affect the prognosis and quality of life of patients with liver disease. On the basis of the results of this study, muscle weakness occurs with mild progression of liver dysfunction in patients with chronic liver disease; thus, physical therapy intervention should be included for chronic liver diseases. Furthermore, this study suggests that because patients with liver disease who show muscle weakness also exhibit low hemoglobin levels, physical therapists should prescribe appropriate exercises and perform risk monitoring of patients during exercise to prevent and improve muscle weakness in chronic liver disease patients.
Keywords: chronic liver disease, muscle strength (secondary sarcopenia), multiple regression analysis
Funding acknowledgements: The present work was supported by the Japanese Society of Physical Therapy (JSPT).
Purpose: The purpose of this study was to investigate the influence of liver dysfunction on physical function in patients with chronic liver disease and clarify the factors that affect physical function across the board.
Methods: The subjects were 102 patients with chronic liver disease admitted to the Department of Gastroenterology and Metabolism, Hiroshima University Hospital. Liver function, which represents the degree of progression of liver disease, was categorized using the Child-Pugh classification (A/B/C), which includes Child-Pugh scores from 5 to 15 points based on five items (total bilirubin [T-Bil], prothrombin time [PT], albumin, ascites, and encephalopathy). All subjects in this study were Child-Pugh class A. The subject's basic data such as sex, age, and body mass index (BMI) were collected, and their appendicular skeletal muscle mass, grip strength, usual gait speed (which is a representative index for sarcopenia diagnosis), and single-leg standing time were measured to determine their physical function. Blood data (T-Bil, albumin, aspartate aminotransferase, alanine, platelet, hemoglobin levels and PT) at the beginning of hospitalization were collected from the medical records. The patients were classified into two groups of Child-Pugh scores 5 (Child 5; n=83, 33 female subjects) and 6 (Child 6; n=19, 8 female subjects), which comprise Child-Pugh classification A, and then compared using the Wilcoxon´s and chi-square tests. The factors associated with the physical function that showed a difference between the two groups were investigated using multiple regression analysis.
Results: There was no significant difference in sex, age(65.1±12.4 v.s.68.9±6.6), and BMI(26.1±4.7 v.s.26.1±7.1) between the Child 5 and 6 groups. Grip strength was significantly lower in the Child 6 group than in the Child 5 group. Prothrombin time and albumin and hemoglobin levels were significantly lower in the Child 6 group than in the Child 5 group. On multiple regression analysis with grip strength as the dependent variable and sex, age, BMI, PT, and albumin and hemoglobin levels as independent variables, the regression equation(R*2=0.635, p 0.001) revealed sex(β=-0.527, p 0.01), age(β=-0.383, p 0.01), and hemoglobin level(β=0.244, p 0.01) to be significant explanatory variables.
Conclusion(s): When mild liver dysfunction occurs in patients with chronic liver disease, they exhibit muscle weakness. It has been revealed that female sex, aging, and low hemoglobin levels are associated with muscle weakness in chronic liver disease.
Implications: In recent years, sarcopenia has been reported to affect the prognosis and quality of life of patients with liver disease. On the basis of the results of this study, muscle weakness occurs with mild progression of liver dysfunction in patients with chronic liver disease; thus, physical therapy intervention should be included for chronic liver diseases. Furthermore, this study suggests that because patients with liver disease who show muscle weakness also exhibit low hemoglobin levels, physical therapists should prescribe appropriate exercises and perform risk monitoring of patients during exercise to prevent and improve muscle weakness in chronic liver disease patients.
Keywords: chronic liver disease, muscle strength (secondary sarcopenia), multiple regression analysis
Funding acknowledgements: The present work was supported by the Japanese Society of Physical Therapy (JSPT).
Topic: Professional practice: other; Non-communicable diseases (NCDs) & risk factors; Disability & rehabilitation
Ethics approval required: Yes
Institution: The institutional review board of the participating clinical sites
Ethics committee: The Ethical Committee for Epidemiology of Hiroshima University
Ethics number: Epi-583-1
All authors, affiliations and abstracts have been published as submitted.
