Effects of an individualized nutritional intervention on the prognosis of patients with liver failure.

BACKGROUND AND OBJECTIVES

Patients with liver failure often have energy metabolism disorders and malnutrition, which lead to poor prognosis, rendering nutritional interventions essential.

METHODS AND STUDY DESIGN

Individualized nutritional interventions were offered according to the resting energy expenditure (REE) of patients with liver failure, and the patients were followed up for 180 days.

RESULTS

Sixty patients with liver failure were enrolled and grouped by their prognosis and energy intake. Model for end-stage liver disease (MELD) score and body fat mass of the nonsurvival group were significantly higher than those of the survival group (p<0.05), whereas the mean energy intake/REE (MEI/REE) and mean respiratory quotient (RQ) of the nonsurvival group were significantly lower than those of the survival group (p<0.01). Prediction REE (PredREE) was calculated using the Harris-Benedict formula. Most patients in the nonsurvival and survival groups had hypometabolic (REE/PredREE <0.9) and normal metabolic status (0.9<REE/PredREE<1.1; p=0.014), respectively. MEI/REE, MELD score, and REE/PredREE were independent predictors of survival in patients with liver failure. The optimal threshold for MEI/REE was 1.15 for predicting favorable prognosis, and the sensitivity and specificity of the threshold were 61.1% and 85.0%, respectively. The survival rates of patients in the <1.2-REE group and ≥1.2-REE group were 45.2% and 88.0%, respectively (p=0.001).

CONCLUSIONS

Hypometabolism state and insufficient energy intake predict poor prognosis in patients with liver failure. Individualized nutritional interventions with energy intake ≥1.2 REE may improve the RQ and prognosis of such patients.