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Open AccessArticle

Impact of Bacterial Translocation on Sarcopenia in Patients with Decompensated Cirrhosis

Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
Department of Medicine, the Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44106, USA
CIBERehd Hospital general Universitario de Alicante, 03010 Alicante, Spain
Instituto de Salud Carlos III, 28029 Madrid, Spain
Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Author to whom correspondence should be addressed.
Nutrients 2019, 11(10), 2379;
Received: 20 August 2019 / Revised: 25 September 2019 / Accepted: 27 September 2019 / Published: 5 October 2019
(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)
Advanced liver disease is associated with a persistent inflammatory state, derived from abnormal bacterial translocation from the gut, which may contribute to the development of sarcopenia in cirrhosis. We aim to document the association of chronic inflammation and bacterial translocation with the presence of sarcopenia in cirrhosis. We prospectively followed cirrhotic patients aged 18–70 years with medically refractory ascites at a single tertiary care center in Toronto, Canada. The baseline data included patient demographic variables, the presence of bacterial DNA in serum/ascitic fluid, systemic inflammatory response syndrome (SIRS) status, and nutritional assessment. Thirty-one patients were enrolled, 18 (58.1%) were sarcopenic, 9 (29%) had bacterial DNA in serum and ascites fluid. The mean MELD score was 11.5 ± 4.0 (6–23). Sarcopenic and non-sarcopenic patients did not differ significantly in their baseline MELD scores, caloric intake, resting energy expenditure, the incidence of bacterial translocation, or SIRS. While sarcopenia was not linked to increased hospital admissions or death, it was strongly associated with increased episodes of acute kidney injury (3 vs. 0, p = 0.05). This pilot study did not demonstrate an association between sarcopenia and SIRS or bacterial translocation. These results should be confirmed in future larger studies, encompassing a greater number of chronic inflammation events and quantifying levels of bacterial DNA.
Keywords: sarcopenia; bacterial translocation; ascites; cirrhosis; SIRS; hypermetabolism sarcopenia; bacterial translocation; ascites; cirrhosis; SIRS; hypermetabolism
MDPI and ACS Style

Tsien, C.; Antonova, L.; Such, J.; Garcia-Martinez, I.; Wong, F. Impact of Bacterial Translocation on Sarcopenia in Patients with Decompensated Cirrhosis. Nutrients 2019, 11, 2379.

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