Giri Patal, Taneja Sunil, Sahni Nancy, Bhujade Harish, Padhi B K, Karki Tanka, Garg Pratibha, Rathi Sahaj, De Arka, Verma Nipun, Premkumar Madhumita, Duseja Ajay
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Clin Gastroenterol Hepatol. 2025 Jun;23(7):1164-1173.e2. doi: 10.1016/j.cgh.2024.09.021. Epub 2024 Oct 24.
BACKGROUND & AIMS: Improvement in the nutritional status of patients with acute-on-chronic liver failure (ACLF) may lead to reduction in morbidity and mortality. This study assessed the impact of dietician-supported outpatient intensive nutrition therapy (OINT) on survival and frailty in patients with alcohol-related ACLF METHODS: Seventy patients with alcohol-related ACLF (Asia Pacific Association for the Study of the Liver [APASL] criteria) and frailty were randomized 1:1 to receive standard medical therapy (SMT) plus OINT (intervention) vs SMT (control) alone. The primary outcome was an improvement in survival at 3 months. Secondary outcome measures included improvement in frailty, prognostic scores, and hospitalization.
There was a significant improvement in overall survival in the OINT group as compared with the SMT group after 3 months of follow up (91.4% [standard error (SE), 4.7%] vs 57.1% [SE, 8.4%]; P < .00). On Cox regression model, inclusion in the intervention arm, baseline skeletal muscle index (SMI), and APASL ACLF Research Consortium (AARC score) were independent predictors of survival (P < .05). The liver frailty index (LFI) score also significantly improved in the OINT as compared with SMT (Δ-0.93; 95% confidence interval, -0.71 to 1.13 vs Δ -0.33; 95% confidence interval, -0.44 to 0.72; P < .00). The disease severity including MELD, MELD-Na, and AARC score showed a significant improvement in the OINT group as compared with the SMT group (P < .05). The patients in OINT group had lesser number of hospitalizations 6 (17%) vs 16 (45.7%) (P = .01) as compared with the SMT group.
Outpatient intensive nutrition therapy significantly improves survival, frailty, and disease severity with a reduction in number of hospitalizations and supports the key role of nutrition in treatment of patients with alcohol-related ACLF.
ctri.nic.in/ CTRI/2022/01/039735.
改善慢性失代偿期急性肝衰竭（ACLF）患者的营养状况可能会降低发病率和死亡率。本研究评估了营养师支持的门诊强化营养治疗（OINT）对酒精性ACLF患者生存及衰弱情况的影响。方法：70例符合亚太肝脏研究学会（APASL）标准且存在衰弱的酒精性ACLF患者按1:1随机分组，分别接受标准药物治疗（SMT）加OINT（干预组）或单纯SMT（对照组）。主要结局为3个月时生存率的改善。次要结局指标包括衰弱情况的改善、预后评分及住院情况。
随访3个月后，OINT组的总生存率较SMT组有显著改善（91.4%[标准误（SE），4.7%]对57.1%[SE，8.4%]；P <.00）。在Cox回归模型中，纳入干预组、基线骨骼肌指数（SMI）及APASL ACLF研究联盟（AARC评分）是生存的独立预测因素（P <.05）。与SMT组相比，OINT组的肝脏衰弱指数（LFI）评分也有显著改善（Δ -0.93；95%置信区间，-0.71至1.13对Δ -0.33；95%置信区间，-0.44至0.72；P <.00）。与SMT组相比，OINT组的疾病严重程度指标包括终末期肝病模型（MELD）、MELD-Na及AARC评分均有显著改善（P <.05）。与SMT组相比，OINT组患者的住院次数较少，分别为6次（17%）对16次（45.7%）（P =.01）。
门诊强化营养治疗显著提高了生存率、改善了衰弱及疾病严重程度，减少了住院次数，支持了营养在酒精性ACLF患者治疗中的关键作用。
ctri.nic.in/CTRI/2022/01/039735
