Nutritional status and prognosis in cirrhotic patients

Abstract

Background and aims: Malnutrition is commonly associated with chronic liver disease. The presence of protein-calorie malnutrition has been shown to be associated with increased short-and long-term mortality in patients with acute and chronic liver disease. We undertook this study to assess the prognostic value of nutritional status in predicting survival in cirrhotic patients. The aim of our study was to determine whether assessment of nutritional status using the RFH-SGA score adds significantly to CP (Child-Pugh) and MELD scores in predicting patient prognosis and survival in cirrhotic patients. Methods: Diagnosed cases of cirrhosis were enrolled and their nutritional assessment was done using the RFH-SGA score. All patients were followed up for a period of 6 months. The mortality rates in the various groups were compared with respect to their nutritional status. Multivariate analysis was used to determine the factors associated with mortality. Results: A total of 73 cirrhotic patients were taken up for this study. Of these, 23 patients (31.5%) were well nourished, 21 (28.8%) had mild to moderate malnourishment and 29 (39.7%) were severely malnourished. Multivariate analyses of various parameters identified poor nutritional status, increased CP grade, increased creatinine, lower sodium levels and longer prothrombin time as being independently associated with poorer survival. Conclusions : RFH-SGA is a simple and inexpensive tool for assessing the nutritional status in cirrhotic patients and can reliably predict their disease prognosis and survival.

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

“…Meta‐analysis: Twenty‐two studies with a total of 4057 were meta‐analysed with a combined increased RR of pre‐transplant mortality in those patients who were malnourished vs not of 2.38 (95% CI 1.96‐2.89, I 2 55%) (Figure ) . When separated by individual NATs, similar results were seen (Table ).…”

“…24,40 Meta-analysis: Twenty-two studies with a total of 4057 were meta-analysed with a combined increased RR of pre-transplant mortality in those patients who were malnourished vs not of 2.38 (95% CI 1.96-2.89, I 2 55%) ( Figure 2). 3,20,[22][23][24][25]34,38,40,[42][43][44]46,48,53,54,[58][59][60][63][64][65] When separated by individual NATs, similar results were seen (Table 1). Seven studies of sarcopenia via cross-sectional imaging (n = 1278) were meta-analysed ( Figure S1)…”

“…Forty-one articles met inclusion criteria 3,20-59 and were systematically evaluated, but of these, only 27 studies had data appropriate for meta-analysis. 3,[20][21][22][23][24][25]28,[34][35][36]38,[40][41][42][43][44][45][46][47][48][52][53][54]58,59 The search was repeated on February 14, 2018, restricted to articles published since August 5, 2017. Sixty-three further abstracts yielded 12 articles for full-text review and 6 articles which could be included in the study.…”

“…All studies: Twenty-five studies included pre-transplant mortality data in some form, 3,20,[22][23][24][25]32,34,38,40,[42][43][44]46,48,50,53,54,[58][59][60][62][63][64][65] with a total of 42 NAT data points across studies. Twenty-nine (69%) of evaluated NAT data points were predictive of pretransplant mortality, while 12 (29%) were not and 1 (2%) did not have sufficient statistical data to assess objectively.…”

Nutrition in Chronic Liver Disease: A Point‐of‐Care Review

“…On the other hand, the Royal Free Hospital–Global Assessment (RFH‐GA), developed by Morgan et al, has good reproducibility in patients with cirrhosis and accurately predicts morbidity and mortality in patients with chronic liver disease . The utility of RFH‐GA in clinical practice is limited because of its being cumbersome.…”