Nutritional Evaluation of Hospitalized Patients with Hepatic Cirrhosis and the Impact on the Prognosis of the Disease: a Cross-Sectional Study

Abstract

Introduction. Nutritional assessment in patients with cirrhosis is complex; the application of the Royal Free Hospital Global Assessment (RFH-GA) in this population is recommended. On the other hand, sarcopenia represents an independent risk factor for mortality, and it is hard to measure in clinical practice. Currently, it is recommended to evaluate muscle strength as a predictor of probable sarcopenia. Objectives. To describe the nutritional status by using the RFH-GA and muscle strength; its association with Child-Pugh and complications of the disease in hospitalized patients with hepatic cirrhosis at Dr. C. B. Udaondo Hospital. Materials and Methods. Data on nutritional assessment, dynamometry, Child-Pugh, and complications in patients with cirrhosis were collected between January 2019 and March 2020. Statistical analyses were performed using STATA software (Stata version 14.0 Corp, College Station, TX, USA). Results. A sample of 129 (75.2% male) middle aged patients (53 years old) was obtained. The main causes of cirrhosis were alcohol (56.6%) and NASH (12.4%). According to the ChildPugh scale, 50.4% were B and 38% C. 42% of the sample suffers from malnutrition and 37.2% low dynamometry. Median dynamometry was 26.3 kg, being lower in females (p < 0.0001). A significant association was found between nutritional status/grip strength and Child-Pugh (p = 0.048 and p = 0.042, respectively); an association between nutritional status and grip strength was also observed (p < 0.001). Regarding complications, low grip strength (aOR: 4.53, 95% CI: 1.66-12.41; p = 0.003) was associated with hepatic encephalopathy; male (aOR: 3.71, 95% CI: 1.28-10.79; p = 0.005), malnutrition (aOR: 3.77, 95% CI: 1.15-12.32; p = 0.028) and child B/C (aOR: 54.2, 95% CI: 6.43-456.81; p < 0.001) were associated with ascites; and male (aOR: 3.66, 95% CI: 1.2211.02; p = 0.021) and malnutrition (aOR: 3.43, 95% CI: 1.39-8.48; p = 0.008) were associated with spontaneous bacterial peritonitis. Conclusion. It is convenient to combine both tools, RFH-GA and dynamometry to identify patients with malnutrition and probable sarcopenia and, thus, initiate early and individualized nutritional treatment.