Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

Table 1 Baseline characteristics

Variablen (%) or mean ± SD	Decompensated, n = 79	Compensated, n = 22	P value
Gender M/F	42 (53.2)/ 37 (46.8)	11 (50)/ 11 (50)	NS
Age	61.3 ± 10	64.5 ± 10.9	NS
Child-Pugh A/B/C	8(10.1%)/32(40.5%)/39(49.4%)	19(86.4%)/3(13.6%)/0(0%)	< 0.001
Aetiology			0.005
Viral	30 (38.0)	16 (72.7)
Alcohol	32 (51.9)	3 (13.6)
Other	5 (10.1)	3 (13.6)
Platelet count (109/L)	122.9 ± 86.9	123.1 ± 60.9	NS
INR	1.82 ± 0.53	1.27 ± 0.25	< 0.001
Total bilirubin (mg/dL)	5.4 ± 6.9	1.2 ± 0.7	0.006
Albumin (g/L)	3.1 ± 0.6	3.9 ± 0.7	< 0.001
AST (U/L)	83.3 ± 67.4	56.6 ± 29.5	0.08
ALT (U/L)	42.3 ± 42.7	46.6 ± 31.2	NS
Haemoglobin (g/dL)	10.9 ± 3.9	12.7 ± 2.2	0.05
Na (mEq/L)	134.5 ± 7.0	139.9 ± 3.3	< 0.001
Creatinine (mg/dL)	1.19 ± 0.88	0.77 ± 0.19	< 0.001
Cholesterol (mg/dL)	120.5 ± 51.4	154.7 ± 39.1	0.01
Triglycerides (mg/dL)	80.9 ± 42.6	78.1 ± 22.5	NS
Child Pugh score	9.6 ± 2.6	5.8 ± 1.2	< 0.001
MELD score	19.2 ± 7.6	11.2 ± 5.6	< 0.001

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International normalized ratio; MELD: Model for end-stage liver disease; NS: Not significant.

Table 2 Comparison between decompensated and compensated patients regarding the nutritional status and the principal nutrients intake, n (%)

Variable	Decompensated, n = 79	Compensated, n = 22	P value
MAC (cm)	25.8 ± 3.9	27.9 ± 2.9	0.02
MAC < 10th	48 (60.8)	6 (27.3)	0.005
MAC < 5th	30 (38.0)	4 (18.2)	0.08
SGA			< 0.001
A (normal)	25 (31.6)	19 (86.4)
B (mild-moderate)	35 (44.3)	3 (13.6)
C (severe)	19 (24.1)	0 (0)
BMI	26.6 ± 4.7	27.1 ± 3.3	NS
Kilocalories/d	2080 ± 419	2200 ± 601	NS
Kcal/kg/d	29 ± 8	30.1 ± 9.2	NS
Proteins (g/kg/d)	1.4 ± 0.4	1.4 ± 0.5	NS
Proteins 1.2-1.5 g/kg/d	20 (25.3)	6 (27.3)	NS
Proteins < 1.2 g/kg/d	27 (34.2)	6 (27.3)	NS
Salt (mmol/d)1	147 ± 4.2	147 ± 4.8	NS
< 120mmol/d	20 (25.3)	6 (27.3)	NS

¹The current recommendation for no added salt diet in patients with ascites is 4.6-6.9 g/d (80-120 mmol/d); NS: Not significant; MAC: Mid-arm circumference; SGA: Subjective Global Assessment; BMI: Body mass index.

Table 3 Univariate and multivariate analysis of factors associated with mortality

Variable	Univariate analysis; OR (95%CI)	P value	Multivariate analysis1; OR (95%CI)	P value
Age	1.03 (1.01-1.06)	0.004	1.03 (1.00-1.06)	0.002
Child-Pugh score	1.13 (1.04-1.23)	0.002	1.09 (0.98-1.20)	0.09
MELD score	1.06 (1.03-1.09)	< 0.001
Presence if malnutrition2	1.82 (1.12-2.94)	0.01
Creatinine (mg/dL)	1.94 (1.46-2.57)	< 0.001	2.13 (1.31-3.45)	0.03
INR	1.60 (1.05-2.43)	0.02
Albumin (g/L)	0.45 (0.29-0.68)	0.01
Cholesterol (mg/dL)	0.99 (0.98-0.99)	0.02
Serum sodium (mEq/L)	0.94 (0.90-0.98)	0.003
Protein intake 1.2-1.5 g/kg/d3	0.51 (0.28-0.90)	0.02	0.40 (0.20-0.77)	0.007

¹In order to avoid collinearity between repeating variables, in model were included: Age, Child-Pugh score, presence of malnutrition, creatinine, cholesterol, serum sodium and protein intake.

²According to Subjective Global Assessment criteria.

³Adherence to protein intake recommendation was analysed. INR: International normalized ratio; MELD: Model for End-Stage Liver Disease.