A retrospective study of enteral nutrition utilization and clinical outcomes in patients with cirrhosis diagnosed with severe malnutrition

Abstract

Backgrounds/Aims

We evaluated the utilization of enteral feeding and clinical outcomes in hospitalized patients with cirrhosis diagnosed with severe protein calorie malnutrition.

Methods

This was a single center retrospective review of hospitalized patients with cirrhosis from 2019-2023. ICD-10-CM code E43 was used to identity patients with a diagnosis of severe protein calorie malnutrition. Study groups for comparison were patients with and without enteral nutrition support during hospitalization. Wilcoxon rank sum and two sample t-tests were used to examine differences in the averages of continuous variables, and Chi-square and Fisher exact tests were used to investigate differences for categorical variables.

Results

Of the 96 patients with cirrhosis and severe protein calorie malnutrition, 31 patients (32%) received enteral nutrition. Time from admission to initiation of enteral feeding was on average 7 days with a mean total duration of enteral nutrition of 10 days. The comparative analysis showed a significant increase in length of stay, intensive care requirement, bacteremia, gastrointestinal bleeding, discharge MELD 3.0 score and in hospital mortality rates (p ≤ 0.05) among patients who received enteral nutrition.

Conclusions

Less than fifty percent of patients hospitalized with cirrhosis received enteral nutrition despite having a diagnosis of severe protein calorie malnutrition. Initiation of enteral nutrition was found to be delayed a week, on average, after hospital admission. Prolonged length of stay and higher in-hospital mortality rates suggest a lack of benefit of enteral nutrition when started late in the hospital course.