Malnutrition assessed through phase angle and its relation to prognosis in patients with compensated liver cirrhosis: A prospective cohort study

Background: Malnutrition is a frequent complication of cirrhosis and it has been associated to more severe disease and development of complications. Phase angle is a bedside reliable tool for nutritional assessment based on conductivity properties of body tissues. Aim: To evaluate the association between malnutrition assessed through phase angle and mortality in patients with liver cirrhosis. Methods: We performed a prospective cohort study in a tertiary care centre; 249 patients were enrolled with 48 months of follow-up. Clinical, nutritional (malnutrition = phase angle <= 4.9 degrees) and biochemical evaluations were performed. Student's t-test and chi(2) method were used as appropriate. Kaplan-Meier curves and multivariate Cox regression were used to evaluate mortality. Results: Mean follow-up was 33.5 months. Survival analysis showed higher mortality in the malnourished group compared to the well-nourished group (p = 0.076), Kaplan-Meier curves were further stratified according to compensated and decompensated status showing higher mortality in compensated patients according to Child-Pugh (p = 0.002) and Model for End-Stage Liver Disease score (p = 0.008) when malnutrition was present. Multivariate analysis showed that malnutrition was independently associated with mortality (HR= 2.15, 1.18-3.92). Conclusions: In our cohort, malnutrition was independently associated with mortality. This is the first study showing higher mortality in malnourished compensated cirrhotic patients. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.