Tesis

Hubungan Sarkopenia dan Malnutrisi dengan Varises Esofagus Risiko Tinggi pada Sirosis Hati = Association of Sarcopenia and Malnutrition with Esophageal Varices High Risk of Liver Cirrhosis.

Latar Belakang: Sarkopenia dan malnutrisi merupakan komplikasi sirosis hati dekompensata yang berhubungan dengan luaran klinis yang buruk. Varises esofagus (VE) merupakan luaran klinis yang paling sering ditemui pada pasien sirosis hati dekompensata. Hubungan komplikasi Varises Esofagus risiko tinggi dengan kejadian sarkopenia dan malnutrisi belum banyak dilakukan di Indonesia. Tujuan : mengetahui hubungan antara sarkopenia dan malnutrisi terhadap luaran komplikasi VE risiko tinggi pada pasien sirosis hati. Metode: Studi observasional cross-sectional dilakukan pada 155 pasien di RS Cipto Mangunkusumo pada Januari hingga September 2023. Sarkopenia didefinisikan sebagai kehilangan massa dan kekuatan otot dan atau menurunnya performa fisik sesuai dengan kriteria AWGS 2019 (Asian Working Group for Sarcopenia). Kriteria malnutrisi menggunakan GLIM (Global Leadership Initiative on Malnutrition). Analisis multivariat dilakukan menggunakan regresi logistik. Hasil: Total 155 pasien sirosis hati, 48 pasien memiliki VE risiko tinggi dan 107 pasien memiliki VE risiko rendah. Prevalensi sarkopenia pada pasien sirosis hati ditemukan sebesar 42,6%, sementara prevalensi malnutrisi ditemukan sebesar 82,6%. Kombinasi koeksistensi sarkopenia dan malnutrisi ditemukan sebesar 42,6%. Status sarkopenia berhubungan secara statistik dengan kejadian VE risiko tinggi setelah dikontrol dengan variabel Child Pugh (Adjusted PR: 1,62 (IK 95%: 1,01-2,59; p=0,04). Sementara itu tidak ditemukan hubungan yang bermakna antara malnutrisi dengan kejadian VE risiko tinggi. Pada evaluasi kombinasi koeksistensi dua faktor risiko sarkopenia dan malnutrisi, ditemukan hubungan yang bermakna terhadap kejadian VE risiko tinggi. Kesimpulan: Terdapat hubungan signifikan antara sarkopenia terhadap VE risiko tinggi. Selain itu, adanya koeksistensi sarkopenia dan malnutrisi sebagai faktor risiko gabungan secara statistik signifikan dalam kejadian VE risiko tinggi.
Kata kunci: malnutrisi, sarkopenia, sirosis hati, varises esofagus


Background: Sarcopenia and malnutrition are complications of decompensated liver cirrhosiswhich is associated with poor clinical outcomes. Esophageal varices (VE) are the most common clinical outcome in patients with decompensated liver cirrhosis.The relationship between high-risk complications of esophageal varices and the incidence of sarcopenia and malnutrition has not been widely studied in Indonesia. Objective :determine the relationship between sarcopenia and malnutrition on the outcome of high-risk VE complications in liver cirrhosis patients. Method: Cross-sectional observational study was conducted on 155 patients at Cipto Mangunkusumo Hospital from January to September 2023. Sarcopenia is defined as loss of muscle mass and strength and/or decreased physical performance according to the 2019 AWGS (Asian Working Group for Sarcopenia) criteria. Malnutrition criteria use GLIM (Global Leadership Initiative on Malnutrition). Multivariate analysis was performed using logistic regression. Results:A total of 155 patients with liver cirrhosis, 48 patients had high risk VE and 107 patients had low risk VE. The prevalence of sarcopenia in liver cirrhosis patients was found to be 42.6%, while the prevalence of malnutrition was found to be 82.6%. The combined coexistence of sarcopenia and malnutrition was found to be 42.6%. Sarcopenia status was statistically related to the incidence of high risk VE after controlling for the Child Pugh variable (Adjusted PR: 1.62 (95% CI: 1.01-2.59; p=0.04). Meanwhile, no significant relationship was found between malnutrition and the incidence of high risk VE. In evaluating the combination of the coexistence of two risk factors for sarcopenia and malnutrition, a significant relationship was found with the incidence of high risk VE. Conclusion:There is a significant relationship between sarcopenia and high risk VE. In addition, the coexistence of sarcopenia and malnutrition as combined risk factors was statistically significant in the occurrence of high-risk VE.
Key words: malnutrition, sarcopenia, liver cirrhosis, esophageal varices