Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions

Abstract

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.

Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico

“…This intake was lower in Mexican‐decompensated patients compared to Americans cohorts and could contribute towards the greater hospitalization rate through microbial change. Nutritional support, which is critical for patients with decompensated cirrhosis, is associated with better outcomes 44,45 . Therefore, these results demonstrate that encouraging animal protein intake through structured nutritional interventions and assessment may be a way forward to favourable impact gut microbiota and, in turn, hospitalizations.…”

Malnutrition in Cirrhosis: Frequent but Overlooked

“…The current study by Reuter et al demonstrated good short‐term outcomes due to early nutritional evaluation and intervention in hospitalized patients with cirrhosis, but a standardized approach for nutritional assessment is not yet available. Although this study evaluated important quality measures (LOS and 90‐day readmission rates), the costs and recruitment of staff for the rigorous employment of this strategy could be challenging.…”

“…(5) The Liver Disease Undernutrition Screening Tool is another MST that uses oral intake, weight loss, loss of subcutaneous fat or muscle mass, volume overload, and functional status. (6) In this issue, Reuter et al (7) performed a study in 3 phases that included awareness education as an intervention to involve dietary professionals earlier in the care of hospitalized patients with cirrhosis. In the retrospective phase of the study, they collected data on the frequency of dietary referrals placed upon admission at 2 transplant centers, nutritional assessment using the RFH-NPT scoring system, length of stay (LOS), and readmission rates.…”

“…Despite the awareness about its significance, malnutrition is frequently underscreened and not aggressively managed in routine practice. The educational intervention proposed in the study by Reuter et al provides an impetus to develop judicious strategies to combat malnutrition in cirrhosis. Appropriate nutritional counseling and interventions in this otherwise sick population would not only improve health outcomes but would also improve health care economics.…”

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

“…Additionally, in order to diminish protein utilization, it is recommended that these patients consume breakfast, 4–6 small meals throughout the day, and a snack consisting of complex carbohydrates and some proteins late at night . Improving the inpatient nutrition consultation rates in cirrhotic patients through education is another proven strategy that is associated with lower readmission rates in 90 days …”