Skladany Lubomir, Vnencakova Jana, Laffers Lukas, Skvarkova Beata, Hrubá Eva, Molcan Pavol, Koller Tomas
Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia.
Department of Mathematics, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia.
Patient Prefer Adherence. 2021 Jan 5;14:2559-2572. doi: 10.2147/PPA.S283034. eCollection 2020.
Patients with advanced chronic liver disease (ACLD) often have a poor nutritional status. In the management, current guidelines recommend dietary counseling and oral nutritional supplements (ONS). Nutritional goals and adherence to ONS are difficult to achieve while studies addressing adherence are scarce. We aimed to evaluate adherence to ONS, the associated factors, and its impact on outcome among ALCD patients who are discharged from the hospital.
We identified consecutive hospitalized patients with ACLD from the cirrhosis registry and ONS prescription at discharge. Baseline demographics, anthropometrics, hand-grip strength (HGS), nutritional, and laboratory parameters were recorded. Adherence was assessed at 30, 90, and 180 days, but not in patients who did not survive or in those who underwent liver transplantation (LT) before the time-point.
From the registry containing 1004 patients, we included 450 cases, the median age was 56.3 (IQR 47-62), 60% were males, 63.8% had alcoholic etiology, and the median model for end-stage liver disease score (MELD) was 16 (11-21). During follow-up, 13.6%, 23.6%, and 31.1% of patients have died within 30, 90, and 180 days, respectively, and 21 underwent LT. Adherence to ONS in surviving patients was observed in 46%, 26.1%, and 16.9% within 30, 90, and 180 days, respectively. Baseline refractory ascites (HR=0.43, 0.24-0.76), HGS (HR=1.03, 1.01-1.06), and mid-arm circumference (HR=0.93, 0.88-0.99) were independently associated with 30-day adherence. Among patients who survived beyond 30 days, adherents for >30 days had improved synthetic liver function, HGS, a higher probability of LT (HR=1.7, 1.03-2.8) and lower risk of death (HR=0.65, 0.45-0.89), particularly those with MELD>16 (OR=0.55, 0.36-0.85) and low HGS (OR=0.61, 0.39-0.93).
In ACLD patients after discharge, adherence to ONS steeply declined and was associated with baseline refractory ascites and low muscle strength. Adherence to ONS also improved liver function, muscle strength, and survival.
晚期慢性肝病（ACLD）患者通常营养状况较差。在管理方面，当前指南推荐饮食咨询和口服营养补充剂（ONS）。营养目标和ONS依从性难以实现，而关于依从性的研究稀缺。我们旨在评估ACLD出院患者的ONS依从性、相关因素及其对结局的影响。
我们从肝硬化登记处和出院时的ONS处方中确定连续住院的ACLD患者。记录基线人口统计学、人体测量学、握力（HGS）、营养和实验室参数。在30、90和180天时评估依从性，但未在未存活患者或在该时间点前接受肝移植（LT）的患者中评估。
在包含1004例患者的登记处中，我们纳入了450例，中位年龄为56.3岁（四分位间距47 - 62岁），60%为男性，63.8%有酒精性病因，终末期肝病模型（MELD）评分中位数为16（11 - 21）。在随访期间，分别有13.6%、23.6%和31.1%的患者在30、90和180天内死亡，21例接受了LT。存活患者在30、90和180天内的ONS依从性分别为46%、26.1%和16.9%。基线难治性腹水（HR = 0.43，0.24 - 0.76）、HGS（HR = 1.03，1.01 - 1.06）和上臂中部周长（HR = 0.93，0.88 - 0.99）与30天依从性独立相关。在存活超过30天的患者中，依从超过30天的患者肝功能合成改善、HGS改善、LT概率更高（HR = 1.7，1.03 - 2.8）且死亡风险更低（HR = 0.65，0.45 - 0.89），尤其是MELD>16（OR = 0.55，0.36 - 0.85）和HGS低（OR = 0.61，0.39 - 0.93）的患者。
在ACLD出院患者中，ONS依从性急剧下降，且与基线难治性腹水和低肌肉力量相关。ONS依从性还改善了肝功能、肌肉力量和生存率。
