A retrospective study of enteral nutrition utilization and clinical outcomes in patients with cirrhosis diagnosed with severe malnutrition

• Chronic liver disease poses an increased risk for the development of malnutrition • Enteral feeding was delayed in hospitalized cirrhotic patients with malnutrition • Higher in-hospital mortality rates were observed with late enteral feeding • Future evaluation of early enteral feeding in this patient population is needed We evaluated the utilization of enteral feeding and clinical outcomes in hospitalized patients with cirrhosis diagnosed with severe protein calorie malnutrition. This was a single center retrospective review of hospitalized patients with cirrhosis from 2019-2023. ICD-10-CM code E43 was used to identity patients with a diagnosis of severe protein calorie malnutrition. Study groups for comparison were patients with and without enteral nutrition support during hospitalization. Wilcoxon rank sum and two sample t-tests were used to examine differences in the averages of continuous variables, and Chi-square and Fisher exact tests were used to investigate differences for categorical variables. Of the 96 patients with cirrhosis and severe protein calorie malnutrition, 31 patients (32%) received enteral nutrition. Time from admission to initiation of enteral feeding was on average 7 days with a mean total duration of enteral nutrition of 10 days. The comparative analysis showed a significant increase in length of stay, intensive care requirement, bacteremia, gastrointestinal bleeding, discharge MELD 3.0 score and in hospital mortality rates (p ≤ 0.05) among patients who received enteral nutrition. Less than fifty percent of patients hospitalized with cirrhosis received enteral nutrition despite having a diagnosis of severe protein calorie malnutrition. Initiation of enteral nutrition was found to be delayed a week, on average, after hospital admission. Prolonged length of stay and higher in-hospital mortality rates suggest a lack of benefit of enteral nutrition when started late in the hospital course.