Nutritional assessment tool for predicting sarcopenia in chronic liver disease

Abstract

Background

Subjective global assessment (SGA) and Royal Free Hospital-global assessment (RFH-GA) are clinically useful for assessing malnutrition. This study aimed to investigate the relationship between sarcopenia, which predicts poor clinical outcomes in patients with chronic liver disease (CLD), and these two methods.

Methods

This retrospective study included 240 consecutive patients admitted to our hospital between October 2011 and January 2014. Sarcopenia and RFH-GA were evaluated using anthropometric measurements and computed tomography-based skeletal muscle area. The primary outcome was whether nutritional assessment methods could predict sarcopenia. In addition, factors associated with sarcopenia and mortality were evaluated.

Results

The median age was 70 years, 67% were men, and 17% had sarcopenia. Malnourished patients assessed by SGA (P = 0.02) and RFH-GA (P < 0.001) had a significantly higher prevalence of sarcopenia than did well-nourished patients. After adjustment for age, sex, aetiology, and albumin, multivariate analysis revealed that RFH-GA, but not SGA, was a significant predictor of sarcopenia [odds ratio, 2.47; 95% confidence interval (CI), 1.15–5.33]. During a median follow-up of 2.7 years, 113 patients died. The overall survival rates were significantly lower in malnourished patients assessed by SGA (P < 0.001) and RFH-GA (P < 0.001) than in well-nourished patients. Multivariate analysis revealed that RFH-GA [hazard ratio (HR), 1.51; 95% CI, 1.02–2.23] and SGA (HR, 1.99; 95% CI, 1.19–3.32) were independently associated with mortality.

Conclusions

Royal Free Hospital-global assessment is a simple bedside screening tool for identifying sarcopenia and predicting mortality in patients with CLD.