BACKGROUND: Skeletal muscle alterations are associated with higher mortality and morbidity in patients with liver cirrhosis. Assessing these changes seems to be a promising method for identifying patients at a high risk of poor outcomes following liver transplantation (LT). This is particularly important given the current global shortage of organ donors. However, evidence of the impact of these alterations on the prognosis of patients undergoing LT is inconclusive. The aim of our prospective study was to evaluate the impact of skeletal muscle changes, reflected in sarcopenia, myosteatosis and metabolic changes in the calf muscles, on perioperative outcomes and long-term survival after LT. We also sought to determine the posttransplant evolution of the resting muscle metabolism. METHODS: We examined 134 adult LT candidates. Of these, 105 underwent LT. Sarcopenia and myosteatosis were diagnosed by measuring the skeletal muscle index and mean psoas muscle radiation attenuation, respectively, which were obtained from computed tomography (CT) scans taken during pretransplant assessment. Additionally, patients underwent 31P MR spectroscopy (MRS) of the calf muscles at rest before LT and 6, 12 and 24 months thereafter. The median follow-up was 6 years. RESULTS: Patients with abnormal 31P MRS results and CT-diagnosed myosteatosis prior to LT had significantly worse long-term survival after LT (hazard ratio (HR), 3.36; 95% confidence interval (CI), 1.48-7.60; p = 0.0021 and HR, 2.58; 95% CI, 1.06-6.29; p = 0.03, respectively). Multivariable analysis showed that abnormal 31P MR spectra (HR, 3.40; 95% CI, 1.50-7.71; p = 0.003) were a better predictor of worse long-term survival after LT than myosteatosis (HR, 2.78; 95% CI, 1.14-6.78; p = 0.025). Patients with abnormal 31P MR spectra had higher blood loss during LT (p = 0.038), required a higher number of red blood cell transfusions (p = 0.006) and stayed longer in ICU (p = 0.041) and hospital (p = 0.007). Myosteatosis was associated with more revision surgeries following LT (p = 0.038) and a higher number of received red blood cell transfusion units (p = 0.002). Sarcopenia had no significant effect on posttransplant patient survival. An improvement in the resting metabolism of the calf muscles was observed at 12 and 24 months after LT. CONCLUSIONS: Abnormal 31P MRS results of calf muscles were superior to CT-based diagnosis of myosteatosis and sarcopenia in predicting perioperative complications and long-term survival after LT. Resting muscle metabolism normalized 1 year after LT in most recipients.
- MeSH
- Adult MeSH
- Muscle, Skeletal * diagnostic imaging metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Spectroscopy * methods MeSH
- Tomography, X-Ray Computed * methods MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Sarcopenia etiology metabolism MeSH
- Aged MeSH
- Liver Transplantation * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Growth differentiation factor (GDF)-15 is a pleiotropic cytokine that is associated with appetite-suppressing effects and weight loss in patients with malignancy. OBJECTIVES: This study aims to investigate the relationships between GDF-15 levels, anorexia, cachexia, and clinical outcomes in patients with advanced heart failure with reduced ejection fraction (HFrEF). METHODS: In this observational, retrospective analysis, a total of 344 patients with advanced HFrEF (age 58 ± 10 years, 85% male, 67% NYHA functional class III), underwent clinical and echocardiographic examination, body composition evaluation by skinfolds and dual-energy x-ray absorptiometry, circulating metabolite assessment, Minnesota Living with Heart Failure Questionnaire, and right heart catheterization. RESULTS: The median GDF-15 level was 1,503 ng/L (Q1-Q3: 955-2,332 ng/L) (reference range: <1,200 ng/L). Higher GDF-15 levels were associated with more prevalent anorexia and cachexia. Patients with higher GDF-15 had increased circulating free fatty acids and beta-hydroxybutyrate, lower albumin, cholesterol, and insulin/glucagon ratio, consistent with a catabolic state. Patients with higher GDF-15 had worse congestion and more severe right ventricular dysfunction. In multivariable Cox analysis, elevated GDF-15 was independently associated with risk of the combined endpoint of death, urgent transplantation, or left ventricular assist device implantation, even after adjusting for coexisting anorexia and cachexia (T3 vs T1 HR: 2.31 [95% CI: 1.47-3.66]; P < 0.001). CONCLUSIONS: In patients with advanced HFrEF, elevated circulating GDF-15 levels are associated with a higher prevalence of anorexia and cachexia, right ventricular dysfunction, and congestion, as well as an independently increased risk of adverse events. Further studies are warranted to determine whether therapies altering GDF-15 signaling pathways can affect metabolic status and clinical outcomes in advanced HFrEF.
- MeSH
- Weight Loss * MeSH
- Cachexia * etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Anorexia * etiology MeSH
- Retrospective Studies MeSH
- Growth Differentiation Factor 15 * blood MeSH
- Aged MeSH
- Heart Failure * complications physiopathology blood MeSH
- Stroke Volume physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Febrility majú mnoho príčin. Najčastejšou je infekcia. Môžu sa vyskytovať aj pri onkologických ochoreniach. Febrility spôsobené priamo malignitou sa nazývajú paraneoplastické. Ich diagnostika môže byť niekedy veľmi zložitá a zdĺhavá a pred- stavuje terapeutickú výzvu aj pre skúseného lekára, pretože predstavujú nezanedbateľné percento horúčok neznámeho pôvodu. Nápomocný môže byť tzv. naproxénový test. Hladiny zápalových parametrov môžu byť niekedy zavádzajúce – pri aktívnej malignite môžu byť výrazne zvýšené. Okrem toho sa febrility u onkologického pacienta môžu vyskytovať aj z príčin infekcie, ktorá vznikne v dôsledku malígnej kachexie alebo pri febrilnej neutropénii, ktorá vzniká ako nežiaduci účinok chemoterapie, ďalej iatrogénne (po ožiari alebo po podaní chemoterapeutík), pri postihnutí centrálneho nervového systému primárnou malignitou alebo metastázami, v rámci adrenálnej krízy pri liečbe glukokortikoidmi alebo po podaní transfúzie.
Fevers have many causes. The most common is infection. They can also occur in oncological diseases. Fevers caused directly by malignancy are called paraneoplastic. Their diagnosis can sometimes be very complex and lengthy and represents a therapeutic challenge even for an experienced physician; therefore they represent a non-negligible percentage of fevers of unknown origin. The so-called can be helpful naproxen test. Levels of inflammatory parameters can sometimes be misleading - they can be significantly elevated in active malignancy. In addition, febrility in an oncology patient can also occur due to infection, which arises as a result of malignant cachexia or febrile neutropenia, which arises as an adverse effect of chemotherapy, further iatrogenically (after radiation or after the administration of chemotherapeutic drugs), when the central nervous system is affected by primary malignancy or metastases, as part of an adrenal crisis during glucocorticoid treatment or after transfusion.
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Karcinom pankreatu (KP), jehož incidence je v západních zemích na vzestupu, patří mezi nádory s nejhorší prognózou. KP je již v časných stadiích provázen nádorovou kachexií, systémovým postižením, které vede k vyčerpání hostitelových substrátových rezerv. Cílem projektu je identifikovat klíčové metabolické dráhy nádoru a tukové tkáně asociované s nádorovou kachexií. Pacienti s KP budou charakterizováni (antropometrie, inzulínová citlivost a sekrece, substrátová utilizace, zánětlivé parametry) s cílem komplexní metabolické diagnostiky nádorové kachexie. Primární kultury z nádoru budou podrobeny metabolomické analýze, zejména ve vztahu k metabolizmu glutaminu a aminokyselin s větveným řetězcem, a interferenci jejich degradačních drah. Ve vzorku peripankreatického tuku bude analyzována lipolytická a sekreční aktivita. U diferencovaných adipocytů bude sledována schopnost inzulín-senzitizujících látek omezit uvolňování lipidů vyvolané nádorovým médiem. Výsledky umožní popsat substrátový cross-talk hostitele a nádoru a identifikovat její potenciální léčebné cíle kachexie u KP.; Pancreatic cancer (PC), whose incidence is increasing in the Western countries, ranks among tumours with the worst prognosis. PC is associated with early development of cancer cachexia, a systemic condition leading to the depletion of host substrate reserves. The project aims to identify key metabolic pathways of the tumour and adipose tissue related to cancer cachexia. Patients with PC will be characterized (anthropometry, insulin sensitivity and secretion, substrate utilization, inflammatory parameters) to describe complex metabolic phenotype. Primary cultures of the tumour will be subjected to metabolomics analyses, specifically related to glutamine and branched chain amino acid metabolism and interference of their degradation pathways. Peripancreatic fat will be analysed for its lipolytic and secretory activity. In differentiated adipocytes, the ability of insulin sensitizing drugs to ameliorate lipolysis induced by tumour medium will be assessed. Results will enable to describe host-tumour substrate cross-talk and to identify potential treatment targets of PC induced cachexia.
- Keywords
- Karcinom pankreatu, Pancreatic cancer, inzulínová rezistence, insulin resistance, glutaminolýza, glutaminolysis, nádorová kachexie, cancer cachexia, Lipolýza, BCAA, Lipolysis, BCAA,
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
- MeSH
- Diagnostic Techniques, Cardiovascular MeSH
- Health Care Economics and Organizations MeSH
- Cachexia etiology MeSH
- Cardio-Renal Syndrome etiology MeSH
- Contraindications, Procedure MeSH
- Humans MeSH
- Heart-Assist Devices MeSH
- Disease Progression * MeSH
- Ventricular Remodeling MeSH
- Liver Failure etiology MeSH
- Heart Failure * complications MeSH
- Histocompatibility Testing methods MeSH
- Heart Transplantation methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Geriatric Assessment methods MeSH
- Cachexia etiology physiopathology MeSH
- Frail Elderly MeSH
- Kwashiorkor etiology physiopathology prevention & control MeSH
- Humans MeSH
- Protein-Energy Malnutrition etiology physiopathology prevention & control psychology MeSH
- Sarcopenia * etiology physiopathology prevention & control MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Muscular Disorders, Atrophic etiology physiopathology MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Review MeSH
Osteomalacie patří mezi metabolické osteopatie a je charakterizována poruchou mineralizace nově tvořeného osteoidu. Etiologie onemocnění je široká a zahrnuje vrozené a získané příčiny. Tyto příčiny vedou většinou k chybění substrátů mineralizace (vápník, fosfáty) nebo k porušenému procesu mineralizace. V praxi může být klinický obraz osteomalacie neúplný a laboratorní obraz může zahrnovat širokou škálu odchylek. Z těchto důvodů může být diagnóza osteomalacie stanovena opožděně nebo zaměněna za jinou patologii skeletu. Osteomalacie patří rutinně do diferenciální diagnostiky při nálezu nízké kostní denzity, i když se s ní ve srovnání s osteoporózou setkáváme v klinické praxi vzácněji. Léčba onemocnění závisí na vyvolávající příčině a při správné diagnostice může dojít k plnému vyléčení. Prezentujeme kazuistiku pacienta ze standardního lůžkového interního oddělení, u kterého nebyla diagnóza osteomalacie jednoznačná. Kazuistika popisuje 75letého kachektického pacienta s malnutriční osteomalacií při nepoznané chronické pankreatitidě.
Osteomalacia belongs to the metabolic osteopathies and is characterized by a mineralization disorder of the newly formed osteoid. The etiology of the disease is broad and includes congenital and acquired causes. These causes usually lead to a lack of mineralization substrates (calcium, phosphates) or to an impaired mineralization process. In practice, the clinical picture of osteomalacia can be incomplete, and the laboratory picture can include a wide range of deviations. For these reasons, the diagnosis of osteomalacia may be delayed or mistaken for another skeletal pathology. Osteomalacia is routinely included in the differential diagnosis when low bone density is found, although it is less common in clinical practice compared to osteoporosis. The treatment of the disease depends on the underlying cause, and with the correct diagnosis, a full cure can occur. We present a case report of a patient from a standard inpatient ward, in whom the diagnosis of osteomalacia was not clear. The case report includes a 75-year-old cachectic patient with malnourished osteomalacia with unrecognized chronic pancreatitis.
- MeSH
- Pancreatitis, Chronic diagnosis complications MeSH
- Cachexia etiology complications MeSH
- Humans MeSH
- Malabsorption Syndromes etiology complications MeSH
- Osteomalacia * etiology physiopathology MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Úvod: U pacientov s onkologickým ochorením sú poruchy výživy rizikovým faktorom, ktoré komplikujú protinádorovú liečbu a výrazne skracujú prežívanie pacientov. V praxi je kľúčovou podmienkou úspechu posúdenie stavu výživy a včasná nutričná intervencia. Cieľ: Hlavným cieľom príspevku je objasniť postupy ošetrovateľských intervencií pri zabezpečení výživy pacienta s malnutríciou. Metódy: Hlavnou metódou je prípadová štúdia (case study). Výber respondenta bol zámerný. Kritériami výberu boli: pacient s onkologickou diagnózou a malnutríciou, ochotný spolupracovať. Do štúdie sme zaradili 68 ročného pacienta s karcinómom pažeráka. Pacient nám poskytol informácie o svojom zdravotnom stave dobrovoľne a súhlasil s ich spracovaním. Výsledky: Na základe nutričnej anamnézy, antropometrických meraní a laboratórnych vyšetrení bol nutričný stav pacienta vyhodnotený ako malnutrícia. V priebehu štyroch mesiacov sme ordinovanými nutričnými intervenciami - podávaním diéty č.1, tekutín, a nutridrinkov 6 až 8 denne cez perkutánnu endoskopickú gastrostómiu zabezpečovali uspokojovanie potreby výživy u pacienta. Telesnú hmotnosť pacienta sa nám podarilo stabilizovať na hodnote 65-62kg za sledované obdobie 4 mesiacov. Záver: Malnutrícia je najčastejšou sprievodnou diagnózou u onkologických pacientov. Napriek nutričným intervenciám sa stav výživy pacienta zhoršil a po 4 mesiacoch javil známky nádorovej kachexie, čo potvrdili laboratórne parametre.
Introduction: In patients with oncological disease are nutritional disorders a risk factor, which complicate anti-tumor treatment and significantly shorten the survival of patients. In practice, the key condition for success is the assessment of the nutritional status and early nutritional intervention. Objective: The main objective of the paper is explain the procedures of nursing interventions in ensuring the nutrition of a malnourished patient. Methods: The main method is a case study. The choice of the respondent was deliberate. These lection criteria were: a patient with an oncological diagnosis and malnutrition, willing to cooperate. We included a 68-year-old patient with esophageal cancer in the study. The patient provided us with information about his health condition voluntarily and agreed to its processing. Results: Based on nutritional anamnesis, anthropometric measurements and laboratory tests, the patient's nutritional status was evaluated as malnutrition. Over thecourse of five months, we ensured that the patient's nutritional needs were met through a percutaneous endoscopic gastrostomy through prescribed nutritional interventions - administration of diet No. 1 and, liquids, 6 to 8 nutridrinks per day. We managed to measure the patient's body weight stabilize at a value of 65-62kg for the monitored period of 4 months. Conclusion: Malnutrition is the most common accompanying diagnosis in oncology patients. Despite nutritional interventions with the nutritional status of the patient worsened and after 4 months showed signs of tumor cachexia, which was confirmed by laboratory parameters.
- MeSH
- Enteral Nutrition MeSH
- Nutrition Assessment MeSH
- Humans MeSH
- Esophageal Neoplasms * nursing MeSH
- Nutritional Support * MeSH
- Nutrition Therapy methods MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Úvod: U pacientov s onkologickým ochorením sú poruchy výživy rizikovým faktorom, ktoré komplikujú protinádorovú liečbu a výrazne skracujú prežívanie pacientov. V praxi je kľúčovou podmienkou úspechu posúdenie stavu výživy a včasná nutričná intervencia. Cieľ: Hlavným cieľom príspevku je objasniť postupy ošetrovateľských intervencií pri zabezpečení výživy pacienta s malnutríciou. Metódy: Hlavnou metódou je prípadová štúdia (case study). Výber respondenta bol zámerný. Kritériami výberu boli: pacient s onkologickou diagnózou a malnutríciou, ochotný spolupracovať. Do štúdie sme zaradili 68 ročného pacienta s karcinómom pažeráka. Pacient nám poskytol informácie o svojom zdravotnom stave dobrovoľne a súhlasil s ich spracovaním. Výsledky: Na základe nutričnej anamnézy, antropometrických meraní a laboratórnych vyšetrení bol nutričný stav pacienta vyhodnotený ako malnutrícia. V priebehu štyroch mesiacov sme ordinovanými nutričnými intervenciami - podávaním diéty č.1, tekutín, a nutridrinkov 6 až 8 denne cez perkutánnu endoskopickú gastrostómiu zabezpečovali uspokojovanie potreby výživy u pacienta. Telesnú hmotnosť pacienta sa nám podarilo stabilizovať na hodnote 65-62kg za sledované obdobie 4 mesiacov. Záver: Malnutrícia je najčastejšou sprievodnou diagnózou u onkologických pacientov. Napriek nutričným intervenciám sa stav výživy pacienta zhoršil a po 4 mesiacoch javil známky nádorovej kachexie, čo potvrdili laboratórne parametre.
Introduction: In patients with oncological disease are nutritional disorders a risk factor, which complicate anti-tumor treatment and significantly shorten the survival of patients. In practice, the key condition for success is the assessment of the nutritional status and early nutritional intervention. Objective: The main objective of the paper is explain the procedures of nursing interventions in ensuring the nutrition of a malnourished patient. Methods: The main method is a case study. The choice of the respondent was deliberate. These lection criteria were: a patient with an oncological diagnosis and malnutrition, willing to cooperate. We included a 68-year-old patient with esophageal cancer in the study. The patient provided us with information about his health condition voluntarily and agreed to its processing. Results: Based on nutritional anamnesis, anthropometric measurements and laboratory tests, the patient's nutritional status was evaluated as malnutrition. Over thecourse of five months, we ensured that the patient's nutritional needs were met through a percutaneous endoscopic gastrostomy through prescribed nutritional interventions - administration of diet No. 1 and, liquids, 6 to 8 nutridrinks per day. We managed to measure the patient's body weight stabilize at a value of 65-62kg for the monitored period of 4 months. Conclusion: Malnutrition is the most common accompanying diagnosis in oncology patients. Despite nutritional interventions with the nutritional status of the patient worsened and after 4 months showed signs of tumor cachexia, which was confirmed by laboratory parameters.
- Keywords
- Perkutánní endoskopická gastrostomie (PEG),
- MeSH
- Enteral Nutrition MeSH
- Gastrostomy methods MeSH
- Nutrition Assessment MeSH
- Feeding Methods MeSH
- Minimally Invasive Surgical Procedures MeSH
- Neoplasms classification MeSH
- Nutritional Support MeSH
- Nutritional Status MeSH
- Nutrition Therapy MeSH
- Malnutrition diagnostic imaging diagnosis nursing therapy MeSH
- Protein-Energy Malnutrition diagnostic imaging diagnosis nursing therapy MeSH
