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Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 143-147

Dynamic scoring of appetite predicts inpatient survival in patients with acute-on-chronic liver failure

1 Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Nursing Services, Christian Medical College, Vellore, Tamil Nadu, India
3 Wellcome Trust Research Laboratory, Division of GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
4 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Ashish Goel
Department of Hepatology, Christian Medical College, Ida Scudder Road, Vellore - 632 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ghep.ghep_8_21

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Background and Aim: Decreased appetite is common in patients with liver disease and may be mediated by inflammatory cytokines. Acute-on-chronic liver failure (ACLF) is associated with raised inflammatory cytokines. The aim of this study was to evaluate appetite scoring as a predictor of inhospital survival in patients with ACLF. Methods: In a prospective observational study, consecutive hospitalized patients with ACLF were recruited. Appetite was assessed daily using Simplified Nutritional Appetite Questionnaire (SNAQ). The total SNAQ score ranged from 4 to 20, and a change in SNAQ score ≥1 was considered significant. Patients received standard medical care. Outcome was defined as good when patient was discharged in a stable condition and as poor if patient died or was discharged in terminal state. Results: Seventy-five ACLF patients (mean age 44 years; 66 males) were recruited. The median length of hospital stay was 5 (range: 1–20) days. Outcome was good in 50 and poor in 25 patients. Patients with good outcome had higher Day 1 SNAQ score (median: 12, range: 7–16) than patients with poor outcome (median: 10, range: 5–16) (P < 0.001). The area under receiver operating characteristic curve to predict poor outcome was 0.71 (95% confidence interval [CI]: 0.56–0.86) for Day 1 SNAQ score and 0.90 (95% CI: 0.82–0.98) for SNAQ δ. When divided into tertiles based on Day 1 SNAQ score, the outcome was good for all patients whose appetite improved and poor for all patients whose appetite worsened on Day 3. Conclusion: Appetite (SNAQ) scores on Day 1 and change on Day 3 predict inhospital survival in ACLF patients. SNAQ is a simple bedside tool which may help in guiding therapeutic decisions in ACLF patients. Further larger studies are required to validate these findings.

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