Background:Malnutrition is recognised as a preoperative risk factor for patients undergoing hepatic resection.It is important to identify malnourished patients and take preventive therapeutic action before surgery.How...Background:Malnutrition is recognised as a preoperative risk factor for patients undergoing hepatic resection.It is important to identify malnourished patients and take preventive therapeutic action before surgery.However,there is no evidence regarding which existing nutritional assessment score(NAS)is best suited to predict outcomes of liver surgery.Methods:All patients scheduled for elective liver resection at the surgical department of the University Hospital of Heidelberg and the Municipal Hospital of Karlsruhe were screened for eligibility.Twelve NASs were calculated before operation,and patients were categorised according to each score as being either at risk or not at risk for malnutrition.The association of malnutrition according to each score and occurrence of at least one major complication was the primary endpoint,which was achieved using a multivariate logistic regression analysis including established risk factors in liver surgery as covariates.Results:The population consisted of 182 patients.The percentage of patients deemed malnourished by the NAS varied among the different scores,with the lowest being 2.20%(Mini Nutritional Assessment)and the highest 52.20%(Nutritional Risk Classification).Forty patients(22.0%)had a major complication.None of the scores were significantly associated with major complications.Conclusions:None of the twelve investigated NAS defined a state of malnutrition that was independently associated with postoperative complications.Other means of measuring malnutrition in liver surgery should be investigated prospectively.展开更多
Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related mortality.Several new drugs f...Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related mortality.Several new drugs for NASH-treatment are currently investigated.No study thus far directly compared surgical and non-surgical therapies for NASH.This network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical approach.Methods:The study was conducted according to the PRISMA guidelines for network meta-analysis.PubMed,CENTRAL and Web of Science were searched without restriction of time or language using a validated search strategy.Studies investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were selected.Patients with liver cirrhosis were excluded.Risk of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was applied.Main outcomes were NASH-resolution and improvement of fibrosis.Results:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were included.NASH-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after surgery.The network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).Surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between them.The results did not change when only new drugs specifically developed for the treatment of NASH were included.Conclusions:Metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of fibrosis.Trials directly comparing surgery with medication must be urgently conducted.Patients with NASH should be informed about surgical treatment options.展开更多
基金We acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme Open Access Publishingthe Baden-Württemberg Ministry of Science,Research and the ArtsRuprecht-Karls-Universität Heidelberg.
文摘Background:Malnutrition is recognised as a preoperative risk factor for patients undergoing hepatic resection.It is important to identify malnourished patients and take preventive therapeutic action before surgery.However,there is no evidence regarding which existing nutritional assessment score(NAS)is best suited to predict outcomes of liver surgery.Methods:All patients scheduled for elective liver resection at the surgical department of the University Hospital of Heidelberg and the Municipal Hospital of Karlsruhe were screened for eligibility.Twelve NASs were calculated before operation,and patients were categorised according to each score as being either at risk or not at risk for malnutrition.The association of malnutrition according to each score and occurrence of at least one major complication was the primary endpoint,which was achieved using a multivariate logistic regression analysis including established risk factors in liver surgery as covariates.Results:The population consisted of 182 patients.The percentage of patients deemed malnourished by the NAS varied among the different scores,with the lowest being 2.20%(Mini Nutritional Assessment)and the highest 52.20%(Nutritional Risk Classification).Forty patients(22.0%)had a major complication.None of the scores were significantly associated with major complications.Conclusions:None of the twelve investigated NAS defined a state of malnutrition that was independently associated with postoperative complications.Other means of measuring malnutrition in liver surgery should be investigated prospectively.
文摘Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related mortality.Several new drugs for NASH-treatment are currently investigated.No study thus far directly compared surgical and non-surgical therapies for NASH.This network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical approach.Methods:The study was conducted according to the PRISMA guidelines for network meta-analysis.PubMed,CENTRAL and Web of Science were searched without restriction of time or language using a validated search strategy.Studies investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were selected.Patients with liver cirrhosis were excluded.Risk of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was applied.Main outcomes were NASH-resolution and improvement of fibrosis.Results:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were included.NASH-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after surgery.The network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).Surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between them.The results did not change when only new drugs specifically developed for the treatment of NASH were included.Conclusions:Metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of fibrosis.Trials directly comparing surgery with medication must be urgently conducted.Patients with NASH should be informed about surgical treatment options.
