Analysis Of The Factors Associated With Malnutrition In Patients With Cirrhosis Assessed By RFH-NPT Combined With GLIM

Objective: Application of Royal Free Hospital-Nutrition Priority Tool(RFH-NPT)in combination with Global Leadership Initiative on Malnutrition(GLIM),to explore the occurrence of malnutrition risk and malnutrition in cirrhosis in China and analyze the related factors affecting malnutrition risk and malnutrition,providing clinical evidence for nutritional intervention in patients with cirrhosis in China.Methods: From August 2020 to December 2021,the amount of 226 patients diagnosed with cirrhosis and were hospitalized in a third-class hospital in northern Shaanxi were selected.Malnutrition risk screening was conducted according to RFH-NPT,and the patients were divided into groups with and without malnutrition risk.GLIM was then used to assess the nutrition of those at risk of malnutrition,divided into non-malnutrition,moderate malnutrition,and severe malnutrition groups.At the same time,other clinical information on all patients was collected,including general information such as age,gender,cause and activity;anthropometry indexes such as BMI,AC,TSF,AMC;laboratory indexes such as blood routine,Liver function,electrolytes;liver function score such as Child-pugh grade,MELD score;complications(upper gastrointestinal bleeding,infection,portal vein thrombosis,hepatic encephalopathy.Single and multifactorial logistic regression was used to analyze the factors related to malnutritional risk or malnutrition and to determine the risk factors of malnutritional risk or malnutrition.Results: 1.According to RFH-NPT,the incidence of malnutrition risk was 54.87%.According to GLIM,the incidence of malnutrition was 48.67%,and the incidence of severe malnutrition was 21.24%.2.(1)In the groups based on RFH-NPT,activity,BMI,AC,AMC,LYM,HB,TP,ALB,AST,GGT,ALP,AST/ALT,TBIL,DBIL,IBIL,RBP,K,Na,CL and Ca showed statistically significant differences between the two groups(P < 0.05),while there was no difference in ALT,P,Mg and FPG between the two groups.(2)In the groups based on GLIM,there were statistically significant differences in BMI,AC,TSF,AMC,LYM,HB,TP,ALB,AST,ALT,GGT,ALP,AST/ALT,TBIL,DBIL,IBIL,RBP,K,Na,Cl and Ca among the three groups(P < 0.05).3.(1)In the groups based on RFH-NPT,there were statistically significant differences in ascites and hepatic encephalopathy between the two groups(P < 0.05).Disease stage,Child-pugh grade and MELD score had statistically significant differences between the two groups(P < 0.05).(2)In the groups based on GLIM,there was statistically significant difference in ascites,infection,portal vein thrombosis and hepatic encephalopathy among the three groups(P < 0.05).Disease stage,Child-pugh grade and MELD score had statistically significant differences among the three groups(P< 0.05).4.Multiple factor analysis showed that AMC decreased(OR=5.992,95% CI:2.798-12.533,P<0.01),Child-pugh B/C grade(OR=19.589,95% CI:5.538-69.292,P<0.01),daily walking < 30 minutes(OR=5.591,95% CI:2.191-14.269,P<0.01)and ALB(OR=1.115,95% CI:1.022-1.216,P=0.014<0.05)were risk factors for malnutrition risk,while LYM(OR=0.463,95% CI:0.266-0.807,P=0.007<0.01)is protective factors for the risk of malnutrition.Compared with the non-malnutrition group,Child-pugh B/C grade and daily walking < 30 minutes were risk factors for moderate and severe malnutrition,and LYM was a protective factor for moderate and severe malnutrition.Conclusion: 1.According to RFH-NPT,the incidence of malnutritional risk in patients with cirrhosis was 54.87%;According to GLIM,the incidence of malnutrition was48.67%,and the incidence of severe malnutrition was 21.24%.2.Compared with patients with cirrhosis who were not at malnutrition risk or malnourished,patients with cirrhosis at malnutrition risk or malnourished had lower anthropometric indexes,nutritional indexes and electrolytes levels,higher liver enzyme levels,more decompensated cirrhosis and Child-pugh B/C patients,higher MELD score,higher incidence of ascites,infection,portal vein thrombosis,hepatic encephalopathy and other complications,more patients walked less than 30 minutes a day.3.When patients with cirrhosis have AMC reduction,Childpugh B/C grade,and daily walking < 30 min,it is recommended that clinicians conduct nutritional screening assenments and individualized nutritional interventions on patients in a timely manner.