BackgroundRapid nutrition screening (NS) is vital for apt management in patients with alcoholic liver cirrhosis (ALC).AimTo identify a quick method of NS having high reliability and prognostic significance.MethodsNS of patients with ALC was assessed using mid‐upper arm circumference (MUAC), handgrip strength (HGS), fat‐free mass index (FFMI), and the Royal Free Hospital‐Global Assessment (RFH‐GA). Baseline clinical and biochemical information were recorded along with 90‐day survival data. The classification and regression tree method was used to classify HGS, MUAC, and FFMI values as well nourished (WN), moderately malnourished (MM), and severely malnourished (SM), and their concordance with RFH‐GA categories was assessed using Kendall tau‐b coefficient. The prognostic proficiency of each method was tested by Cox regression analysis.ResultsAccording to the RFH‐GA, of 140 male patients with ALC, 13 of 140 (9.3%) were WN, 93 of 140 (66.4%) were MM, and 34 of 140 (26.8%) were SM. HGS has the strongest association with the RFH‐GA (Kendall tau‐b = 0.772; diagnostic accuracy −81.4%). HGS was found to be the independent predictor of 90‐day mortality (26 of 140 [18.6%]; hazard ratio, 0.93; 95% CI, 0.88–0.98; P = 0.002) after adjusting for age, body mass index, and disease severity. The hazard of mortality was 8.5‐times higher in patients with ALC with HGS < 22 kg as compared with those with HGS > 29.ConclusionHGS is a reliable tool for rapid NS. HGS < 22 kg suggests a high risk for severe malnutrition and is strongly associated with short‐term mortality in male patients with ALC.
Background: Hepatic encephalopathy, which is a serious complication, and sarcopenia are undesirable consequences in cirrhosis. Transjugular intrahepatic portosystemic shunt increases the risk of hepatic encephalopathy. We investigated the effect of sarcopenia on the incidence of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. Methods: Clinical data of patients who underwent transjugular intrahepatic portosystemic shunt were extracted retrospectively. Computed tomography images at L3 level of scans performed prior to transjugular intrahepatic portosystemic shunt were analyzed to assess skeletal muscle index—expressed as skeletal muscle area (cm 2 )/ height (m 2 ). Results: Of 210 patients who underwent transjugular intrahepatic portosystemic shunt, complete information was available in 79 [male: 68 (86%); age: 50.5 ± 11.2 years; Child–Turcotte–Pugh score: 8.81 ± 1.23; etiology—alcohol: 44 (56%), non-alcoholic steatohepatitis: 16 (20%), others: 19 (24%); transjugular intrahepatic portosystemic shunt indication—ascites: 56 (71%); bleed: 23 (29%); sarcopenics: 42 (53%)]. Post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy developed in 29 (37%) patients. In patients who developed hepatic encephalopathy, both serum ammonia [177.6 ± 82.5 vs. 115.5 ± 40.5 µg/dL, P = .008] and prevalence of sarcopenia [69% vs. 44%; P = .02; odds ratio (95% CI): 2.8 (1.08-7.4), P = .02] were higher, with sarcopenics having 3 times higher risk of hepatic encephalopathy and 8 times higher risk of multiple episode of hepatic encephalopathy [31% vs. 5.4%; odds ratio (95% CI): 8.2 (1.68-40.5), P = .009]. In multivariate analysis, age [odds ratio (95% CI): 1.05 (1.001-1.11), P = .047], serum albumin [odds ratio (95% CI): 0.162 (0.05-0.56), P = .004], and skeletal muscle index [odds ratio (95% CI): 0.925 (0.89-0.99), P = .017] were independently associated with post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. Conclusions: Sarcopenia is present in nearly half of the cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt, which increases the risk of a single episode of hepatic encephalopathy by 3-fold and that of multiple episodes of hepatic encephalopathy by 8-fold after transjugular intrahepatic portosystemic shunt procedure. Increased skeletal muscle index is associated with decreased risk of hepatic encephalopathy.
Background Malnutrition increases risk of mortality in critically ill cirrhotics. Modified Nutrition Risk in Critically ill (mNUTRIC) score is a validated tool to identify patients at nutrition risk that may benefit the most from goal directed nutrition therapy. We aimed to study the association between mNUTRIC score and 28-day mortality and its modulation by nutritional adequacy in critically ill cirrhotics. Methods A prospective study in critically ill adult cirrhotics was designed with collection of baseline and follow-up data pertaining to mNUTRIC score, clinical, hemodynamic, biochemical, nutritional parameters, use of mechanical ventilation (MV), length of ICU stay, and development of new onset infection (NOI). Daily nutritional adequacy was calculated as percentage of prescribed energy and protein received. Results 150 cirrhotics [(males-83%, age-51 ± 12.1 years, BMI-24 ± 4.7kg/m2; median LOS 6 (2–24 days)] were enrolled. At ICU admission 116 (77%) had high NUTRIC Score (HNS) and 34 (23%) low NUTRIC score (LNS). Patients with HNS had significantly higher mortality [54% vs. 10%; p = 0.008; OR(95%CI) adjusted 3.0(1.39,6.9;p = 0.006)] for etiology and blood sugar ; longer MV days [5(2–24) vs. 3(1–24) ; p = 0.02]; and high incidence of NOI [32% vs. 2.6%; p = 0.002; OR(95% CI:7(2,24.5)] compared to LNS. A logistic regression analysis for interaction of nutritional adequacy and 28 day survival revealed that the probability of survival increases with increase in nutritional adequacy (p < 0.01) in patients with HNS. Conclusion mNUTRIC score is a useful tool in recognizing nutrition risk in critically ill cirrhotics and goal directed nutrition therapy; especially in patients with high mNUTRIC score can significantly improve survival.
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