P47 Optimizing nutrition in patients with cirrhosis may reduce hospital readmissions in medium and high risk groups: a quality improvement project. (28th September 2020)

• Record Type: Journal Article
• Authors: Liaros, Angela; Connolly, Christine; Potter, Lucy; Jones, Lisa; Gledhill, Tamsin; Sieberhagen, Cyril
• Is Part Of: Gut. Volume 69(2020)Supplement 1
• Page Start: A29
• Page End: A29
• Publication Date: 2020-09-28
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-BASL.57
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Malnutrition adversely affects prognosis in cirrhosis and is often recognized late. All cirrhotic patients should be screened for malnutrition yet this is variably performed. We evaluated the assessment and management of nutrition in cirrhosis by comparing local practice to EASL guidelines, and explored patient outcomes after a focused intervention. Method: Data was collected in 2 cycles. Cycle 1 retrospectively reviewed nutritional assessment of all patients admitted to gastroenterology during September-December 2018 with cirrhosis. An Inpatient Nutrition Proforma (INP) was introduced to record Child-Pugh (CP), anthropometrics, dietary intake, malnutrition risk and nutrition plan. Sarcopenia was assessed in high risk patients using handgrip strength (HGS). All CP-C and BMI <18.5 were high risk. Cycle 2 prospectively audited admissions after intervention (March-June 2019). Calorie-protein intake and HGS after intervention, readmissions and deaths were assessed at 4 months. Results: 47 and 31 patients were identified in cycle 1 and 2, respectively. A Malnutrition Universal Screening Tool (MUST) was completed in 81% of cycle 1 patients. 47% did not trigger a dietetic referral on MUST scoring (44% medium risk and 33% high risk for malnutrition). All cycle 2 patients had a dietetic referral via the INP (26% medium risk and 71% high risk for malnutrition) and received dietary education, with 77% requiring oral supplements and 10% nasogastric feeding. At follow-up, cycle 2 patients met higher caloric and protein requirements (average increase by 46% and 57%, respectively versus 26% and 31% in cycle 1). HGS was measured in 74% in cycle 2 and 2% in cycle 1. Average HGS was 15.9 kg (cycle 2) and improved by 9% on reassessment. There was a 12% reduction in hospital readmissions in cycle 2 compared to 7% increase in cycle 1 with similar mortality at 4 months. Conclusion: MUST inadequately identifies cirrhotic patients at risk of malnutrition. CP and BMI appear more accurate. A dedicated dietetic team and the INP enable early patient identification, thorough nutritional assessment and intervention, improving patient compliance and sarcopenia. Hospital readmission rates reduced over 4 months despite a higher proportion of high risk patients in cycle 2 compared to cycle 1. 12 month follow-up data will assess mortality more accurately. Our intervention forms a platform for wider service development in this area both in the inpatient setting and beyond.