Does Subjective Global Assessment have a role to play in patients with chronic liver disease

Abstract

Malnourishment is common in patients with chronic liver disease and is also highly neglected aspect. We tried to estimate the prevalence of malnourishment in relation to chronic liver disease using Subjective Global Assessment (SGA) and its role as a screening test for malnourishment. We also want to compare nutritional status with severity of chronic liver disease.METHODS: This is a cross-sectional, observational study done at Meenakshi Medical College Hospital and Research Institute, Kanchipuram. Patients with Chronic Liver disease (CLD) above 18 years of age were included. Patients of age less than 18 years, patients with other causes of malnourishment including carcinomas, immunocompromised patients, poorly controlled diabetes were excluded. All patients included in the study were subjected to SGA and routine blood tests for disease staging.RESULTS: After exclusion of 7 patients out of 54, 47 were included. Mean age was 51.6 ± 12.6 years. 89% males, 10% females. 70.2% were malnourished (SGA class B and C). 98% belongs to lower socio-economic status (SES) by Modified Kuppuswamy classes (IV and V). 68.1% were alcoholics, 10.6% had Hepatitis B, 8.5% had non-alcoholic fatty liver disease. 61.7% had disease duration of 13 – 59 months. 25.% had duration of illness > 60 months. 46.8% had normal Body mass index (BMI) (18.1 – 22.9). 27.7 % were underweight (BMI < 18). 23.4% were Obese (BMI > 25). 10.6%, 31.9% and 57.4% belonged to Child-Pugh class A, B and C respectively. 61.7% had Model for end stage liver disease – sodium (MELD-Na) score of > 15. Average MELD-Na score was 18.9. A statistical significance of SGA with BMI, Duration of illness and Child-Pugh class was observed. Although clinical significance was observed for SGA with etiology of chronic liver disease, MELD-Na score, SES, there was no statistical significance.CONCLUSION: SGA is an easy and cheap bedside screening tool to know who are malnourished and classify them according to the severity of malnourishment. Further investigations to conform malnourishment can be planned according to SGA. SGA also associates well with the severity of the disease. SGA should be incorporated into every patient’s management algorithm.