Enteral nutrition in severely malnourished and anorectic cirrhotic patients in clinical practice - Benefit and prognostic factors

Objectives - To determine among severely malnourished cirrhotic patients remaining anorectic during hospital stay which patients may benefit from enteral nutrition in clinical practice. Methods - A prospective study including malnourished cirrhotic patients fed by enteral nutrition because of inadequate dietary intake after one-month hospitalization was carried out in a department receiving patients from other hospitals. Patients who died during hospital stay (N = 35, group I) were compared to surviving patients (N = 28, group II). Results - Nutritional status and spontaneous dietary intake on admission to our department were in the same range in the two groups, Pugh score was higher in group I (11.1 +/- 1.9 vs 9.1 +/- 2.0, P = 0.0001). The delay between previous hospital admission and the outset of enteral nutrition was comparable in the two groups. Its duration and total dietary intake during enteral nutrition were higher in group II (respectively 42.2 +/- 30.9 vs 15.2 +/- 33.1 days, P = 0.0016 and 41.1 +/- 13.0 vs 29.9 +/- 10.0 kcal/kg/d, P = 0.0004). Prevalence of side effects was higher in group I (54.3 vs 17.9%, P = 0.0031). Multivariate analysis showed that Pugh score and septic complications were negatively associated with survival (respectively P = 0.0196 and P = 0.0078) while duration of enteral nutrition was positively associated (P = 0.0435). Eighty six per cent of patients receiving enteral nutrition with bilirubin levels above 74 mu mol/L on admission to our department died during hospital stay. Mid-term effects of enteral nutrition in surviving patients were improvement in Pugh score (7.5 +/- 2.0 vs 9.1 +/- 2.0, P < 0.0001) and increase in spontaneous caloric and protein intake (29.7 +/- 15.3 vs 18.1 +/- 10.1 kcal/kg/d, P = 0.0150 and 1.0 +/- 0.5 vs 0.6 +/- 0.3 g/kg/d, P = 0.0049). Conclusions - In severely malnourished cirrhotic patients remaining anorectic after one-month hospitalization, patients with bilirubin level below 74 mu mol/L may benefit from six-week enteral nutrition with mid-term improvement in liver function and increase in spontaneous dietary intake.