title: Nutritional status and prognosis in cirrhotic patients.
abstract: OBJECTIVE
  The potential prognostic value for survival of nutritional status in cirrhotics after adjusting Child-Pugh classification and Model for End-Stage Liver Disease has not been evaluated.
  
  
  METHODS
  We used Kaplan-Meier and Cox proportional hazards regression models to identify factors associated with mortality in a cohort of 222 cirrhotics [M/F:145/77 median age 52 (18-68) years] with prospectively collected nutritional parameters as well as modified subjective global nutritional assessment, Royal Free Hospital-Subjective Global Assessment index. Follow-up was censored at the time of transplantation. Other variables were ones in Child-Pugh and Model for End-Stage Liver Disease scores, age, aetiology of cirrhosis and renal function.
  
  
  RESULTS
  Pretransplant mortality (Kaplan-Meier) was 21% by 2 years (135 patients were transplanted). Among the nutritional parameters, only Royal Free Hospital-Subjective Global Assessment remained significantly associated with mortality in multivariable models (P = 0.0006). The final model included the following variables: urea (P = 0.0001), Royal Free Hospital-Subjective Global Assessment (P = 0.003), age (P = 0.0001), Child-Pugh grade (P = 0.009) and prothrombin time (P = 0.003). The results were similar when the Child-Pugh grade was replaced by the Model for End-Stage Liver Disease score in the model, and whether a competing risks model was used.
  
  
  CONCLUSIONS
  Nutritional indices add significantly to both Child-Pugh grade and Model for End-Stage Liver Disease scores when assessing the patient prognosis.
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Gunsar
authors.forename: M L
authors.initials: ML
authors.lastname: Raimondo
authors.forename: S
authors.initials: S
authors.lastname: Jones
authors.forename: N
authors.initials: N
authors.lastname: Terreni
authors.forename: C
authors.initials: C
authors.lastname: Wong
authors.forename: D
authors.initials: D
authors.lastname: Patch
authors.forename: C
authors.initials: C
authors.lastname: Sabin
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D012044:Regression Analysis; D015996:Survival Rate