Malnutrition assessed through phase angle and its relation to prognosis in patients with compensated liver cirrhosis: A prospective cohort study

Background: Malnutrition is a frequent complication of cirrhosis and it has been associated to more severe disease and development of complications. Phase angle is a bedside reliable tool for nutritional assessment based on conductivity properties of body tissues. Aim: To evaluate the association between malnutrition assessed through phase angle and mortality in patients with liver cirrhosis. Methods: We performed a prospective cohort study in a tertiary care centre; 249 patients were enrolled with 48 months of follow-up. Clinical, nutritional (malnutrition=phase angle≤4.9°) and biochemical evaluations were performed. Student's t-test and χ² method were used as appropriate. Kaplan-Meier curves and multivariate Cox regression were used to evaluate mortality. Results: Mean follow-up was 33.5 months. Survival analysis showed higher mortality in the malnourished group compared to the well-nourished group (. p=. 0.076), Kaplan-Meier curves were further stratified according to compensated and decompensated status showing higher mortality in compensated patients according to Child-Pugh (. p=. 0.002) and Model for End-Stage Liver Disease score (. p=. 0.008) when malnutrition was present. Multivariate analysis showed that malnutrition was independently associated with mortality (HR. =. 2.15, 1.18-3.92). Conclusions: In our cohort, malnutrition was independently associated with mortality. This is the first study showing higher mortality in malnourished compensated cirrhotic patients.