Impact of nutritional status on cirrhotic inpatients' prognosis: a retrospective monocentric study

Wuestenberghs, Fabien [UCL] Lanthier, Nicolas [UCL] Piessevaux, Hubert [UCL] Dahlqvist, Géraldine [UCL]

Introduction Malnutrition is frequent in cirrhotic patients and is associated with a poor outcome. Role of malnutrition on the prognosis of hospitalized cirrhotic patients is incompletely studied. Aim To determine the prevalence of malnutrition, functional scores and their impact on prognosis of hospitalized cirrhotic patients. Methods This retrospective study included all consecutive patients with cirrhosis hospitalized in the gastroenterology unit at Saint-Luc university hospital from April 2014 to September 2014. Nutritional status was evaluated according to a score used in our centre including weight loss speed, reduction of intakes and body mass index (BMI). We also investigated the role of Charlson comorbidity index, Braden scale and Onodera’s Prognostic Nutritional Index (PNI) depending on both albumin and lymphocyte values. Cirrhosis-related complications or death occurrence were analysed in a one-year follow-up. Patients with unavailable nutritional data or with absence of follow-up were excluded. Results On 113 patients with cirrhosis, 18 were excluded, and the remaining 95 patients were assessed for nutritional status and outcomes. There were 71 men (74.8%). Mean age was 60 years (range 20-84 years). Aetiology of cirrhosis was alcoholic in 58.9%, hepatitis B or C virus in 29.5%, NAFLD in 5.3% and other causes in 6.3% of patients. Hepatocellular carcinoma (HCC) was present in 46.3% of patients. Mean BMI was 27.1 kg/m² ± 6.7. Diabetes mellitus was present in 36.8% of patients. Mean MELD was 13.4 ± 6.6 points. 40% of patients had a Child-Pugh A score, 41% a Child-Pugh B score and 19% a Child-Pugh C score. Malnutrition affected 45.3% of patients: 29% with Child-Pugh A, 48.8% with Child-Pugh B and 72.2% with Child-Pugh C. Mean Braden scale was 21.54 ± 2.25; 46.3% of patients had a Braden scale < 23. During the study period, 58.9% of patients developed cirrhosis-related complications (60.7% in the malnutrition group vs. 39.3%, p<0.001, OR 5.06, IC95 1.90-14.58) and 33.7% of patients died (68.75% vs. 31.25%, p=0.002, OR 4.33, IC95 1.62-12.28). In univariate analysis, sodium <135 mmol/L (p<0.001), MELD >15 (p<0.001), PNI <40 (p=0.003), Braden scale <23 (p=0.047) and malnutrition (p<0.001) were significantly associated with mortality. Adjusting for age, sodium, MELD, Charlson index, HCC, platelets, diabetes, PNI and Braden scale, malnutrition was significantly associated with higher mortality and morbidity rates with an OR of 3.56 (IC95 1.55-8.16) and 2.09 (IC95 1.16-3.77) respectively. Braden scale was significantly associated with higher mortality (p=0.027, OR 1.25, IC95 1.03-1.52) whereas PNI was associated with higher morbidity (p=0.001, OR 0.94, IC95 0.90-0.98). Conclusions Malnutrition is highly prevalent in hospitalized cirrhotic patients. Malnutrition, low PNI and low Braden scale are associated with poor outcomes in cirrhosis.