Low back pain in patients hospitalised with liver cirrhosis- a retrospective study.

BACKGROUND: Lower back pain is a common issue, but little is known about the prevalence of pain in patients with liver cirrhosis during hospitalisation. Therefore, the objective of this study was to determine lower back pain in patients with liver cirrhosis. METHODS: The sample consisted of patients with liver cirrhosis (n = 79; men n = 55; women n = 24; mean age = 55.79 ± 12.52 years). The hospitalised patients were mobile. The presence and intensity of pain were assessed in the lumbar spine during hospitalisation. The presence of pain was assessed using the visual analogue pain scale (0-10). The range of motion of the lower spine was assessed using the Schober and Stibor tests. Frailty was measured by Liver Frailty Index (LFI). The condition of liver disease was evaluated using The Model For the End-Stage Liver Disease (MELD) and Child-Pugh score (CPS) and ascites classification. Student's t test and Mann-Whitney test were used for analysis of the difference of group. Analysis of variance (ANOVA) with the Tukey post hoc test was used to test differences between categories of liver frailty index. The Kruskal-Wallis test was used to test pain distribution. Statistical significance was determined at the α-0.05 significance level. RESULT: The prevalence of pain in patients with liver cirrhosis was 13.92% (n = 11), and the mean intensity of pain according to the visual analogue scale was 3.73 (± 1.90). Lower back pain was present in patients with ascites (15.91%; n = 7) and without ascites (11.43%; n = 4). The prevalence of lower back pain was not statistically significant between patients with and without ascites (p = 0,426). The base of Schober's assessment mean score was 3.74 cm (± 1.81), and based on Stibor's assessment mean score was 5.84 cm (± 2.23). CONCLUSION: Lower back pain in patients with liver cirrhosis is a problem that requires attention. Restricted spinal mobility has been reported in patients with back pain, according to Stibor, compared to patients without pain. There was no difference in the incidence of pain in patients with and without ascites.

Comparison of the quality of life of patients with liver cirrhosis before and during the COVID-19 lockdown in Slovakia.

Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess the quality of life before the pandemic (on the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Patients who were alive (according to the national registry of deaths) were identified and contacted by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment in RH7 and during lockdown) was a standardized and validated EuroQOL-5D (EQ-5D) questionnaire. The study included 97 patients, of which 37 (38.1%) were women and 60 (61.9%) were men. Responses were achieved from 75 patients (68.18%). In general, patients scored their quality of life significantly higher during the pandemic compared to examination at admission to RH7 (that is, at admission to our tertiary liver unit with cirrhosis) (p = 0.005). In particular, of the domains included in EQ-5D: (1) self-care was better during lockdown compared to the first record on admission to RH7 (p < 0.001). (2) the ability to perform daily activities has also improved during lockdown (p = 0.002). On the other hand, (3) pain and discomfort did not change significantly during the lockdown compared to the previous measurement (p = 0.882). (4) anxiety and depression were lower during lockdown compared to admission to RH7 (p = 0.01). The quality of life in patients with liver cirrhosis was better during the lockdown of SARS-CoV-2 compared to the previous measurement at admission to the tertiary liver unit.

Prognostic usefulness of serum myostatin in advanced chronic liver disease: its relation to gender and correlation with inflammatory status.

In hospitalized patients with advanced chronic liver disease (ACLD), we aimed to evaluate the association between myostatin and muscle mass, its relation to inflammation and to assess the added prognostic value of myostatin for survival. In a prospective single-center cohort study, inclusion criteria were: consecutive hospitalization for ACLD and Child-Pugh score ≥ 7 points. Baseline parameters were myostatin, C-reactive protein (CRP), hand-grip strength (HGS), mid-arm muscle circumference (MAC), transversal psoas muscle index (TPMI). Patients were followed-up for at least 400 days. We included 198 men, 157 women, and 40 controls, median myostatin levels in pg/ml were 1790.1 in women, 1959.4 in men, and 3850.0 and 2996.0 in healthy men and women. Myostatin positively correlated with TPMI, but weakly with MAC and HGS, and not in women. Myostatin negatively correlated with CRP in both genders. In cases with CRP 10 mg/l, regression analysis of myostatin versus HGS, MAC or TPMI showed steeper dependence curve. During follow up, 85 men and 64 women (42.9% versus 40.8%) have died, 22 men and 19 women (11.1% versus 12.1%) underwent liver transplantation. Cumulative incidence of death was higher in men with myostatin levels < 1600.0 pg/ml, but not in women. In men, MELD score and myostatin cut-off were independent predictors of worse survival but did not predict survival in women. In men, myostatin levels directly reflect the muscle mass and low levels independently predict worse survival. In women, myostatin is not associated with muscle mass or survival.