OBJECTIVES: Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS: For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child–Turcotte–Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS: Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02–0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02–0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient −1.47, 95% CI −2.39 to −0.56) and KPS (coefficient −3.17, 95% CI −5.02 to −1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION: Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes. Correspondence: Michael A. Dunn, MD. E-mail: dunnma@upmc.edu. SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B481, http://links.lww.com/AJG/B482, http://links.lww.com/AJG/B483, http://links.lww.com/AJG/B484 Received July 16, 2019 Accepted February 03, 2020 © The American College of Gastroenterology 2020. All Rights Reserved.

中文翻译：

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步态速度测试的虚弱是肝移植呼吸系统并发症的危险因素。

目标：虚弱和肌肉减少症是肝移植不良结果和死亡率的已知危险因素。我们假设虚弱或肌肉减少症可以识别常见的严重移植相关不良呼吸事件的风险。方法：对于移植超过 1 年的 107 名患者（74 名男性，33 名女性），我们使用步态速度、椅子站立和 Karnofsky 性能量表 (KPS) 测量虚弱，并使用 L3 计算机断层扫描的骨骼肌指数测量肌肉减少症。我们记录了压力测试的心脏双积作为心脏工作能力的指标。结果包括插管天数、抽吸天数、临床肺炎天数、再插管天数/气管切开天数、出院天数和存活天数。我们使用未经调整的回归和针对 (i) 年龄、性别、终末期肝病模型-Na (MELDNa) 或 Child-Turcotte-Pugh 评分，(ii) 肝细胞癌状态，以及 (iii) 慢性阻塞性肺病和吸烟史。对活体供体肝移植和已故供体肝移植受者进行了亚组分析。结果：步态速度与误吸和肺部感染呈负相关，无论是在未调整模型还是 MELDNa 调整模型中（误吸的调整优势比为 0.10 [95% 置信区间 [CI] 0.02–0.67]，肺部感染的调整优势比为 0.12 [95] % 置信区间 0.02–0.75]）。步态速度（系数 -1.47，95% CI -2.39 至 -0.56）和 KPS（系数 -3.17，95% CI -5.02 至 -1.32）的未调整和 MELDNa 调整模型与较短的插管时间显着相关。没有测试与住院时间长短或是否需要重新插管或气管切开术相关。讨论：缓慢的步态速度是全身虚弱的指标，表明移植后呼吸系统并发症的风险很大。阻止或逆转衰弱的干预措施作为改善移植呼吸结果的潜在可改变风险因素值得探索。通信：Michael A. Dunn，医学博士。电子邮件：dunnma@upmc.edu。本文附带的补充材料位于 http://links.lww.com/AJG/B481、http://links.lww.com/AJG/B482、http://links.lww.com/AJG/B483、http： //links.lww.com/AJG/B484 2019 年 7 月 16 日接受 2020 年 2 月 3 日接受 © 美国胃肠病学会 2020。保留所有权利。表明移植后呼吸系统并发症的重大风险。阻止或逆转衰弱的干预措施作为改善移植呼吸结果的潜在可改变风险因素值得探索。通信：Michael A. Dunn，医学博士。电子邮件：dunnma@upmc.edu。本文附带的补充材料位于 http://links.lww.com/AJG/B481、http://links.lww.com/AJG/B482、http://links.lww.com/AJG/B483、http： //links.lww.com/AJG/B484 2019 年 7 月 16 日接受 2020 年 2 月 3 日接受 © 美国胃肠病学会 2020。保留所有权利。表明移植后呼吸系统并发症的重大风险。阻止或逆转衰弱的干预措施作为改善移植呼吸结果的潜在可改变风险因素值得探索。通信：Michael A. Dunn，医学博士。电子邮件：dunnma@upmc.edu。本文附带的补充材料位于 http://links.lww.com/AJG/B481、http://links.lww.com/AJG/B482、http://links.lww.com/AJG/B483、http： //links.lww.com/AJG/B484 2019 年 7 月 16 日接受 2020 年 2 月 3 日接受 © 美国胃肠病学会 2020。保留所有权利。