Meta-analysis of reference values of cardiorespiratory fitness and impact of interventions in patients with cirrhosis.

INTRODUCTION

Cirrhosis is associated with significant risk of comorbidity and early mortality. Cardiopulmonary exercise testing has the advantage of allowing cardiac, pulmonary and muscle function assessment and could have a better prognosis value than the usual assessment of cardiorespiratory function often evaluated at rest in patients with cirrhosis.

METHODS

We reviewed electronic databases (PubMed, Scopus, Embase, Google Scholar) for relevant literature running up to April 2024.

RESULTS

This review gathers the data from 3029 patients with cirrhosis from 62 studies. Patients with cirrhosis had lower cardiorespiratory fitness (CRF) than age-matched healthy subjects and reference values were meta-analyzed. VO2Peak (mL.min-1.kg-1) and anaerobic threshold (mL.min-1.kg-1) were significantly lower in Child-Pugh C compared to A (p = 0.009) and B (p < 0.001). Supervised exercise proved effective for improving VO2Peak (p < 0.001) before and after transplantation (p < 0.001), but not when conducted in a home-based setting (p = 0.569). Liver transplantation initially (at three months) results in a minor decrease in CRF, but over time (at 12 months) leads to an improvement in CRF.

CONCLUSION

This meta-analysis provides reference values for CRF in patients with cirrhosis and shows the benefits of supervised physical exercise before and after liver transplantation. CRF could help clinicians to prioritize patients on the LT waiting list.