Department of Medicine, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA.
Department of Nutrition, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA.
Liver Transpl. 2019 Dec;25(12):1790-1799. doi: 10.1002/lt.25602. Epub 2019 Aug 21.
Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. We aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90-day readmissions. This study was conducted in 2 phases. Retrospectively, records of hospitalized patients with cirrhosis from the university and Veterans Affairs Medical Center (VAMC) settings were reviewed to assess nutritional status, if a nutrition consultation occurred, the number of days patients were nil per os (npo) and received inadequate nutrition, and if nutritional management was guideline directed. In the prospective phase, after dedicated educational efforts directed at the stakeholders regarding nutritional guidelines for patients with cirrhosis, subsequently hospitalized cirrhosis patients had nutritional and 90-day readmission data collected for comparison between groups. In total, 279 patients were included in the retrospective phase (150 university/129 VAMC), and 102 VAMC patients were in the prospective phase. Cirrhosis severity, reason for admission, and hospital course were similar between groups regardless of cohort, ie, prospective versus retrospective or VAMC versus university. The prospective group had significantly more nutritional consultations and assessments (74.5% versus 40.1%; P < 0.001) compared with the retrospective group regardless of comparisons between the VAMC and university cohorts. Both groups had a similar number of days npo, but the prospective group had fewer days of inadequate nutrition. The 90-day readmission rate was significantly lower in the prospective group versus the retrospective group (39.4% versus 28.4%; P = 0.04), which was associated with greater nutrition outpatient follow-up. In conclusion, nutritional consultation rates in inpatients with cirrhosis can be significantly improved after educational intervention and is associated with lower 90-day readmission rates.
营养不良在肝硬化患者中广泛存在，会加重肌肉减少症、肝性脑病 (HE) 和整体预后不良。我们旨在确定回顾性和前瞻性（在接受教育培训后）队列中肝硬化患者营养评估的频率，并评估前瞻性变化及其对 90 天再入院的影响。这项研究分两个阶段进行。在回顾性阶段，我们回顾了来自大学和退伍军人事务医疗中心 (VAMC) 住院的肝硬化患者的记录，以评估营养状况、是否进行了营养咨询、患者无口服饮食 (npo) 的天数和接受不足营养的天数，以及营养管理是否遵循指南。在前瞻性阶段，在针对肝硬化患者营养指南的利益相关者进行了专门的教育努力后，随后收集了住院肝硬化患者的营养和 90 天再入院数据，以便在组间进行比较。总共纳入 279 例回顾性患者（150 例来自大学/129 例来自 VAMC），102 例 VAMC 患者为前瞻性阶段。无论队列是前瞻性还是回顾性，或者是 VAMC 还是大学，肝硬化严重程度、入院原因和住院过程在两组之间相似。与回顾性组相比，前瞻性组进行了更多的营养咨询和评估（74.5%对 40.1%；P<0.001），无论与 VAMC 和大学队列的比较如何。两组无口服饮食天数相似，但前瞻性组接受不足营养的天数较少。与回顾性组相比，前瞻性组的 90 天再入院率显著降低（39.4%对 28.4%；P=0.04），这与更多的营养门诊随访有关。总之，教育干预后，肝硬化住院患者的营养咨询率可显著提高，与 90 天再入院率降低相关。
