P047 Nutrition in decompensated liver disease: A regional trainee-led audit investigating malnutrition and the impact of nutritional interventions following admission with decompensated chronic liver disease

Abstract

<h3>Introduction</h3> Malnutrition results in prolonged inpatient stay, high readmission rates and poor clinical outcome.^1–3 Malnutrition in cirrhosis is a poor prognostic factor.⁴ Assessing nutritional status is problematic as traditional methods of assessment are inaccurate.⁵Decompensated cirrhosis (DC) patients often require nutritional support but optimal timing of intervention and outcomes are unclear.^{6 7} A regional audit assessing the prevalence of malnutrition in DC, nutritional management, impact on length of stay, readmission and mortality was conducted. <h3>Method</h3> All adults admitted with DC from 1–30 November 2019 to four acute xxxx hospital Trusts were retrospectively identified from coding. Malnutrition was assessed by MUST and Royal Free Hospital–Nutritional Prioritisation Tool (RFH-NPT) screening tools.⁸ <h3>Results</h3> 47 patients were identified. Patient demographics, liver disease aetiology, baseline biochemical, disease severity, nutritional assessment and mortality were collected (table 1). Prevalence of malnutrition was 76.6% (CI 62–87.6%) which was independent of age or aetiology of liver disease but was associated with disease severity. There were higher rates of screening on gastroenterology wards (p=0.012) compared to other wards. Nutritional supplementation was prescribed in 27 (60%) patients, 78% of which was oral supplementation. Median length of hospitalisation was 9 (2–62) days. This was longer in those prescribed nutritional supplements (median 11:7 days). Those prescribed supplements were more likely to have more severe liver disease (MELD 20:15; p=0.006). Readmission rates at 1 month were similar in those prescribed nutritional supplements than those not (35% vs 36%). Mortality was higher in malnourished patients (p=0.03) and in the group of patients prescribed nutritional supplements versus not at 1, 3 and 6 months. <h3>Conclusions</h3> Malnutrition is widespread in DC being present in 76.6% of this cohort as compared to 30% in hospitalised patients. Malnutrition was independently associated with early readmission and mortality. The RFH-NPT was significantly more sensitive for detecting malnutrition in cirrhosis compared to MUST. Though screening was better on Gastroenterology wards, it is of concern that this was incomplete for many patients nor was a dietician review accomplished in all malnourished patients. Our results indicate that initial in-patient nutritional interventions do not appear to impact on early readmission or early mortality. A larger multi-centre audit would be required to evaluate the impact of specific nutritional interventions on longer-term outcomes. We propose early management of malnutrition at all possible clinical interactions with specialty dietician involvement. Both primary and secondary care guidance could be adapted to achieve this. <h3>References</h3> Kyle UG, Genton L, Pichard C. Hospital length of stay and nutritional status. <i>Curr Opin Clin Nutr Metab Care</i> 2005;<b>8</b>(4):397–402. Lim SL, Ong KCB, Chan YH, <i>et al</i>. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. <i>Clin Nutr</i> 2012;<b>31</b>(3):345–350. Charlton K, Nichols C, Bowden S, <i>et al</i>. Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up. <i>Eur J Clin Nutr</i> 2012;<b>66</b>(11):1224. McFarlane M, Hammond C, Roper T, <i>et al</i>. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. <i>Clin Nutr ESPEN</i> 2018;<b>23</b>:156–161. Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. <i>Clin Gastroenterol Hepatol</i> 2012;<b>10</b>(2):117–125. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019;<b>70</b>(1):172–193. Plauth M, Bernal W, Dasarathy S, <i>et al</i>. ESPEN guideline on clinical nutrition in liver disease. <i>Clin Nutr</i> 2019;<b>38</b>(2):485–521. Arora S, Mattina C, Catherine M, <i>et al</i>. PMO-040 the development and validation of a nutritional prioritising tool for use in patients with chronic liver disease. <i>Gut</i> 2012;<b>61</b>:A90.