To: The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation

To the Editor

I would like to congratulate the authors responsible for the article entitled "The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation", the topic of which is extremely relevant to the academic community.⁽¹⁾

This topic, addressing the functional assessment of this patient population, which is highly affected by loss of muscle strength and functionality during the course of the disease and at times of hospital admission, is extremely relevant. For this reason, it raised much interest, and we would like to add some suggestions and observations that we believe are relevant to the study.

Patients with cirrhosis who are candidates for transplantation present with important muscle dysfunction over the course of the disease. Such dysfunction includes changes in muscle mass and strength, which are often associated with changes in functional fitness - factors that limit quality of life and increase mortality before transplantation.⁽²⁾

One aspect related to the worsening of functional status is the time spent on the liver transplant waiting list. In the article, there was no mention of controlling for this variable, which may influence the main outcome of the study. Another criterion to be mentioned is the participation of patients with cirrhosis and hepatopulmonary syndrome, a condition that may be present in up to 30% of patients with cirrhosis. The authors did not exclude this patient subgroup, which may be present in the respective sample and may influence aspects related to dyspnea.⁽³⁾

Regarding the instrument used to measure patient functional status, we suggest the use of another tool because the Perme Intensive Care Unit Mobility Score is a scale developed specifically to evaluate patients admitted to the intensive care unit, and it cannot be used in settings such as inpatient units or outpatient clinics.⁽⁴⁾

REFERÊNCIAS

• ¹
  Pereira CS, Carvalho AT, Bosco AD, Forgiarini Júnior LA. Escala Perme como preditor de funcionalidade e complicações após a alta da unidade de terapia intensiva em pacientes submetidos a transplante hepático. Rev Bras Ter Intensiva. 2019;31(1):57-62.
• ²
  Tandon P, Ney M, Irwin I, Ma MM, Gramlich L, Bain VG, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18(10):1209-16.
• ³
  Iqbal S, Smith KA, Khungar V. Hepatopulmonary syndrome and portopulmonary hypertension: implications for liver transplantation. Clin Chest Med. 2017;38(4):785-95.
• ⁴
  Kawaguchi YM, Nawa RK, Figueiredo TB, Martins L, Pires-Neto RC. Perme Intensive Care Unit Mobility Scale e ICU Mobility Scale: tradução e adaptação cultural para a língua portuguesa falada no Brasil. J Bras Pneumol. 2016;42(6):429-34.

Publication Dates

• Publication in this collection
  20 Jan 2020
• Date of issue
  Oct-Dec 2019

History

• Received
  11 Apr 2019
• Accepted
  13 June 2019