Poor cardiorespiratory fitness is a risk factor for sepsis in patients awaiting liver transplantation

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-1[BULLET OPERATOR]min-1. 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-1[BULLET OPERATOR]min-1; 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. Corresponding Author: Graeme A. Macdonald, MBBS, PhD, FAASLD, Senior Staff Specialist and Associate Professor of Medicine, Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, 4011, Australia. Email: g.macdonald@uq.edu.au. Telephone: +61 (7) 3176 2613, Fax: +61 (7) 3176 5111 AUTHORSHIP PAGE Authorship: M.W. conceived and designed the research, performed and analysed the data, and wrote the article. A.W. performed data collection, contributed to writing and revised the article. A.H. performed data collection and revised the article. T.S. contributed to writing and revised the article. J.C. conceived and designed the research, advised on the research performance, contributed to writing and revised the article. G.M. conceived and designed the research, advised on the performance of the research and revised the article. Disclosures: MW, AH, and TS have no personal or funding interests to disclose. AW has received funding from the Royal Australasian College of Physicians for unrelated work. AW is also supported by the Princess Alexandra Hospital's Research Support Scheme postgraduate scholarship. JC has received an unrestricted research grant from Coca Cola and funding from Renew Corp, Pfizer, Cyanotech, Terumo, Gatorade, Numico, Northfields and Baxter for unrelated work. JC has also received honorariums to present at meetings from Novartis, Amgen and Roche. GM is on an advisory board for AbbVie and has received funding to speak on behalf of MSD and Gilead for unrelated work. Funding: None. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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