Nutritional status and prognosis in cirrhotic patients

SUMMARY Background and Aim  The potential prognostic value for survival of nutritional status in cirrhotics after adjusting Child–Pugh classification and Model for End‐Stage Liver Disease has not been evaluated. Methods  We used Kaplan–Meier and Cox proportional hazards regression models to identify...

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Published in:Alimentary pharmacology & therapeutics 2006-08, Vol.24 (4), p.563-572
Main Authors: GUNSAR, F., RAIMONDO, M. L., JONES, S., TERRENI, N., WONG, C., PATCH, D., SABIN, C., BURROUGHS, A. K.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Digestive system
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver Cirrhosis - mortality
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Nutritional Status
Other diseases. Semiology
Pharmacology. Drug treatments
Prospective Studies
Regression Analysis
Survival Rate
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Summary:SUMMARY Background and Aim  The potential prognostic value for survival of nutritional status in cirrhotics after adjusting Child–Pugh classification and Model for End‐Stage Liver Disease has not been evaluated. Methods  We used Kaplan–Meier and Cox proportional hazards regression models to identify factors associated with mortality in a cohort of 222 cirrhotics [M/F:145/77 median age 52 (18–68) years] with prospectively collected nutritional parameters as well as modified subjective global nutritional assessment, Royal Free Hospital‐Subjective Global Assessment index. Follow‐up was censored at the time of transplantation. Other variables were ones in Child–Pugh and Model for End‐Stage Liver Disease scores, age, aetiology of cirrhosis and renal function, Results  Pretransplant mortality (Kaplan–Meier) was 21% by 2 years (135 patients were transplanted). Among the nutritional parameters, only Royal Free Hospital‐Subjective Global Assessment remained significantly associated with mortality in multivariable models (P = 0.0006). The final model included the following variables: urea (P = 0.0001), Royal Free Hospital‐Subjective Global Assessment (P = 0.003), age (P = 0.0001), Child–Pugh grade (P = 0.009) and prothrombin time (P = 0.003). The results were similar when the Child–Pugh grade was replaced by the Model for End‐Stage Liver Disease score in the model, and whether a competing risks model was used. Conclusions  Nutritional indices add significantly to both Child–Pugh grade and Model for End‐Stage Liver Disease scores when assessing the patient prognosis.
ISSN:0269-2813
1365-2036
DOI:10.1111/j.1365-2036.2006.03003.x