title: Does protein energy malnutrition affect the outcome in Tunisian cirrhotic patients?
abstract: BACKGROUND
  Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostic factor is still under debate. The aims of our study were to determine the prevalence of malnutrition in cirrhotic patients and determine whether this condition was an independent prognostic factor.
  
  
  METHODS
  We prospectively analyzed the nutritional status of 104 consecutive patients with cirrhosis Subjective global nutritional assessment (SGA) and anthropometry [dry body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC)] were used for the evaluation of the nutritional status. Complications of cirrhosis during follow-up and patient's survival were recorded. Global survival and survival without complications was studied by Kaplan Meier method and using Log Rank test.
  
  
  RESULTS
  Prevalence of malnutrition ranged from 16.3 and 62.5% according to the method of nutritional assessment used. Survival without complications was reduced in malnourished patients. This difference was significant when assessing malnutrition by dry BMI (p=0.001). In multivariate analysis, malnutrition defined by dry BMI<18.5 kg/m2 was an independent predictor of complications (p<0.001; RR 3.2) especially hepatic encephalopathy (p=0.001; RR 2.66). In univariate analysis, global survival was worse in malnourished patients (by BMI and SGA; p=0.03 and p=0.0014 respectively), but this trend was lost in multivariate analysis.
  
  
  CONCLUSIONS
  In our study, malnutrition was an independent predictor of complications in cirrhosis. However, it did not appear as an independent prognostic factor for global survival. These results raise again difficulties to clarify whether malnutrition influence itself the prognosis of cirrhosis or if it is only related to the severity of cirrhosis.
authors.forename: Rym
authors.initials: R
authors.lastname: Ennaifer
authors.forename: Myriam
authors.initials: M
authors.lastname: Cheikh
authors.forename: Haifa
authors.initials: H
authors.lastname: Romdhane
authors.forename: Safa
authors.initials: S
authors.lastname: Sabbagh
authors.forename: Houda
authors.initials: H
authors.lastname: Ben Nejma
authors.forename: Wassila
authors.initials: W
authors.lastname: Bougassas
authors.forename: Najet
authors.initials: N
authors.lastname: Bel Hadj