Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients.
OBJECTIVE
This study compared three methods of assessing malnutrition in cirrhotics and correlated nutritional status with clinical outcome.


METHODS
This cross-sectional study evaluated nutritional status by subjective global assessment (SGA), prognostic nutritional index (PNI), and handgrip strength (HG) in outpatients with cirrhosis (n = 50) and two control groups with hypertension (n = 46) and functional gastrointestinal disorders (n = 49). Patients with cirrhosis were followed for 1 y to verify the incidence of major complications, the need for transplantation, and death.


RESULTS
Among patients with cirrhosis, 88% were Child-Pugh A and only 12% were Child-Pugh B. Among these, prevalences of malnutrition were 28% by SGA, 18.7% by PNI, and 63% by HG (P < 0.05). HG, but not SGA or PNI, predicted a poorer clinical outcome in patients with cirrhosis because major complications such as uncontrolled ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome developed in 65.5% of malnourished patients versus 11.8% of well-nourished ones (P < 0.05). No significant differences by any method were seen between the two groups regarding liver transplantation or death.


CONCLUSIONS
There was a high prevalence of malnutrition in cirrhotic outpatients, especially when assessed by HG, which was superior to SGA and PNI in this study. HG was the only technique that predicted a significant incidence of major complications in 1 y in undernourished cirrhotic patients.
Alvares-da-Silva
Mário Reis
MR
Hospital de Clinicas de Porto Alegre, Gastroenterology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. mras@terra.com.br
Reverbel da Silveira
Themis
T
D000328:Adult; D001201:Ascites / Q000150:complications / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000401:mortality; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome