Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12835-12842
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12835
Nutritional care in hospitalized patients with chronic liver disease
Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen
Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia
Dep K Huynh, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
Author contributions: Huynh DK, Nguyen NQ contributed to study concept and design, acquisition, analysis and interpretation of data; statistical analysis and drafting of the manuscript; Selvanderan SP contributed to data acquisition and revision of the manuscript; Harley HAJ contributed to study concept; analysis and interpretation of data and revision of the manuscript; Holloway RH contributed to study concept, analysis and interpretation of data and critical revision of manuscript for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Royal Adelaide Hospital Research Ethics Committee.
Informed consent statement: The need to obtain informed consent from subjects was waived by the Royal Adelaide Hospital Research Ethics Committee.
Conflict-of-interest statement: The authors do not have any conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dep K Huynh, MBBS, FRACP, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia. dep.huynh@health.sa.gov.au
Telephone: +61-8-82225214 Fax: +61-8-82225885
Received: April 16, 2015
Peer-review started: April 18, 2015
First decision: May 18, 2015
Revised: June 11, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: December 7, 2015
Abstract

AIM: To evaluate the practice of nutritional assessment and management of hospitalised patients with cirrhosis and the impact of malnutrition on their clinical outcome.

METHODS: This was a retrospective cohort study on patients with liver cirrhosis consecutively admitted to the Department of Gastroenterology and Hepatology at the Royal Adelaide Hospital over 24 mo. Details were gathered related to the patients’ demographics, disease severity, nutritional status and assessment, biochemistry and clinical outcomes. Nutritional status was assessed by a dietician and determined by subjective global assessment. Estimated energy and protein requirements were calculated by Simple Ratio Method. Intake was estimated from dietary history and/or food charts, and represented as a percentage of estimated daily requirements. Median duration of follow up was 14.9 (0-41.4) mo.

RESULTS: Of the 231 cirrhotic patients (167 male, age: 56.3 ± 0.9 years, 9% Child-Pugh A, 42% Child-Pugh B and 49% Child-Pugh C), 131 (57%) had formal nutritional assessment during their admission and 74 (56%) were judged to have malnutrition. In-hospital caloric (15.6 ± 1.2 kcal/kg vs 23.7 ± 2.3 kcal/kg, P = 0.0003) and protein intake (0.65 ± 0.06 g/kg vs 1.01 ± 0.07 g/kg, P = 0.0003) was significantly reduced in patients with malnutrition. Of the malnourished cohort, 12 (16%) received enteral nutrition during hospitalisation and only 6 (8%) received ongoing dietetic review and assessment following discharge from hospital. The overall mortality was 51%, and was higher in patients with malnutrition compared to those without (HR = 5.29, 95%CI: 2.31-12.1; P < 0.001).

CONCLUSION: Malnutrition is common in hospitalised patients with cirrhosis and is associated with higher mortality. Formal nutritional assessment, however, is inadequate. This highlights the need for meticulous nutritional evaluation and management in these patients.

Keywords: Liver cirrhosis, Nutrition assessment, Mortality, Malnutrition, Morbidity

Core tip: This is the first study to highlight the lack of nutritional assessment of hospitalised patients with cirrhosis. Despite the well-established prognostic value of nutrition, our study showed that almost half of hospitalized patients with cirrhosis did not have a formal nutritional assessment. The prevalence of malnutrition in this group of patients was high (56%) and in-hospital dietary intake was substantially reduced, even in patients with normal subjective global assessment. We also confirmed that malnutrition was an independent predictor of both short-term and long-term mortality.