Identification and prognostic impact of malnutrition in a population screened for liver transplantation

Background & aims: Sarcopenia is prevalent in patients with liver cirrhosis and is negatively associated with clinical outcomes. In a population screened for liver transplantation we aimed to assess the prevalence of abnormal nutritional status and to what extent a clinical screening tool is able to reliably select patients for extensive nutritional assessment including CT. We also evaluated which nutritional parameters are independently associated with clinical outcomes. Methods: Analysis of consecutive patients undergoing detailed nutritional assessment during pre-liver transplantation screening from October 2015 to April 2017. Results: In 102 included patients (66.7% male; median age of 56.3 years (IQR 43.9–64.0); median MELDNa score of 14.7 (IQR 9.4–19.0)), presarcopenia was diagnosed in 30/102 patients (29.4%), sarcopenia in 20/102 (19.6%), and impaired muscle quality in 19/102 (18.6%). Application of the European association for the Study of the Liver rapid screen tool as the primary instrument for nutritional assessment would have resulted in selection of 40/69 cases, thus 42.0% of patients with actual muscle mass depletion and/or impaired muscle function would not have been selected for further nutritional evaluation. In contrast to muscle mass depletion, impaired muscle function was a significant predictor for 6-month decompensation-free (p = 0.006) and hospitalization-free (p = 0.003) survival, when adjusted for age and MELDNa score. Conclusions: In our population the efficacy of a clinical screening tool for malnutrition was unsatisfactory. A detailed nutritional assessment is therefore recommended in all patients undergoing liver transplantation screening. Impaired muscle function might be clinically more relevant than muscle mass depletion, and muscle function testing should be considered an integral part of nutritional assessment in chronic liver disease.