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 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.