In Cirrhosis, Less Activity Equals Worse Outcomes


Daily step count measured by a AA wearable sensor-based personal activity tracker predicted the risk of hospital admission and mortality for cirrhosis patients, a study found.

In the lowest quartile of daily steps (<1,200 steps), after adjustment for the model for end-stage liver disease sodium (MELD-NA) and use of a smartphone-based app designed for end-stage liver disease patients per day) significantly higher risk of hospitalization and death:

  • Hospitalization HR 1.90 (95% CI 1.09–3.30)
  • Mortality HR 3.46 (95% CI 1.23-9.68)

Independent of MELD-na and app use, the risk of hospital admission was reduced by 5% and the risk of death by 12% with walking every additional 500 steps per day, Andres Duarte-Rojo, MD, PhD told. from the University of Pittsburgh School of Medicine in Pennsylvania and colleagues Clinical Gastroenterology and Hepatology,

In addition, better performance in the 6-minute walk test and gait speed test were associated with a lower risk of hospital admission and death, respectively:

  • 6-Minute Walk Test: HR 0.63 (95% CI 0.47-0.83) and HR 0.66 (95% CI 0.44-0.99) per 100 m
  • Gait speed tests: HR 0.29 (95% CI 0.11-0.72) and (HR 0.21, 95% CI 0.05-0.84)

“This is the first study to demonstrate a relationship between stage count and the prevalence of frailty in patients with end-stage liver disease,” the authors wrote.

“The daily stage count could potentially replace or complement the recommended dilution metrics when assessing and identifying end-stage liver disease in adults living in the community,” he said.

“I think the bottom line is that people who don’t move are going to be sick. I would say that the average patient is not overly aggressive in documenting their move or exercise because by the time they come to us, many patients So sick, they are almost immobile,” said Joseph Galati, MD, of Houston Methodist Hospital in Texas, who was not involved in this study.

“If we can give our patients access to these monitoring devices to keep track of their steps and movement that would help,” he said. medpages today, “We really need to do this before it becomes the last step.”

For this study, Duarte-Rojo and colleagues examined data from 116 patients with cirrhosis from the University of Pittsburgh Medical Center. The mean age was 56 years, 55% were male, the MELD-Na score was 15, and the mean body mass index was 31.

Alcohol-related cirrhosis (33%) and non-alcoholic steatohepatitis (30%) were the most common etiologies of liver disease. More than half of the patients were enlisted for liver transplantation.

Patients were excluded if they had received or were ineligible for liver transplantation, did not have access to a smartphone or wireless Internet, or had an exacerbation of hepatic encephalopathy.

Study participants were divided into those using a personal activity tracker alone (Fitbit; n=71) or Tracker Plus el-fit app (n = 45). Weekly monitoring of steps was completed in 80% of those using the tracker with the app, compared to 62% of those using the tracker alone (P=0.040).

During a follow-up of 223 days, 55% of patients were hospitalized and 15% died.

Duarte-Rojo and her colleagues acknowledge that patients with walking disturbances, poor digital literacy, or who experience physical discomfort during exercise may not be able to use a personal activity tracker, which was a part of their study. There was a limit.

  • Zaina Hamza is a staff writer for MedPage Today, covering gastroenterology and infectious disease. He is located in Chicago.

Disclosures

This study was partially funded by the American Association for the Study of Liver Disease Foundation, the Pittsburgh Liver Research Center and the Innovation Institute at the University of Pittsburgh.

Duarte-Rojo and a co-author reported serving as consultants to Excella Health. No other conflicts of interest were reported.

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