Effects of an individualized nutritional intervention on the prognosis of patients with liver failure.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients with liver failure often have energy metabolism disorders and malnutrition, which lead to poor prognosis, rendering nutritional interventions essential. METHODS AND STUDY DESIGN: Individualized nutritional interventions were offered according to the resting energy expenditure (REE) of patients with liver failure, and the patients were followed up for 180 days. RESULTS: Sixty patients with liver failure were enrolled and grouped by their prognosis and energy intake. Model for end-stage liver disease (MELD) score and body fat mass of the nonsurvival group were significantly higher than those of the survival group (p<0.05), whereas the mean energy intake/REE (MEI/REE) and mean respiratory quotient (RQ) of the nonsurvival group were significantly lower than those of the survival group (p<0.01). Prediction REE (PredREE) was calculated using the Harris-Benedict formula. Most patients in the nonsurvival and survival groups had hypometabolic (REE/PredREE <0.9) and normal metabolic status (0.9survival in patients with liver failure. The optimal threshold for MEI/REE was 1.15 for predicting favorable prognosis, and the sensitivity and specificity of the threshold were 61.1% and 85.0%, respectively. The survival rates of patients in the <1.2-REE group and ≥1.2-REE group were 45.2% and 88.0%, respectively (p=0.001).

CONCLUSIONS:

Hypometabolism state and insufficient energy intake predict poor prognosis in patients with liver failure. Individualized nutritional interventions with energy intake ≥1.2 REE may improve the RQ and prognosis of such patients.