Wallen MP; Woodward AJ; Hall A; Skinner TL; Coombes JS; Macdonald GA;

Transplantation [Transplantation] 2018 Jul 13. Date of Electronic Publication: 2018 Jul 13.

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 prior to 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[BULLET OPERATOR]kg[BULLET OPERATOR]min. Their median MELD-Na 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[BULLET OPERATOR]kg[BULLET OPERATOR]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, MELD-Na score, hepatocellular carcinoma diagnosis, presence of ascites, and beta-blocker use.
Conclusion: Poor cardiorespiratory fitness is an independent risk factor for the development of sepsis in advanced liver disease.