Longitudinal Follow-Up of Malnutrition in U.S. Veterans With Decompensated Cirrhosis: 1093

INTRODUCTION: This retrospective cohort study aims to address the overall incidence of formal malnutrition assessments of U.S. veteran patients with decompensated cirrhosis and how these assessments impact clinical outcomes. METHODS: All consecutive adult U.S. veteran patients with a diagnosis of decompensated cirrhosis were identified in the James A. Haley VA Computerized Patient Record System using ICD-9 and ICD-10 codes associated with decompensated cirrhosis. Patients were included in the study if they had at least 2 cross-sectional imaging studies (CT or MRI) approximately 2 years apart from one another in order to identify significant changes in skeletal muscle composition and body fat as a primary outcome. These studies were reviewed and compared by one independent radiologist. Demographic and clinical data were also extracted. Malnutrition assessments were evaluated by one registered dietician (RD) based on review of prior dietician consultation notes that documented clinical evidence of malnutrition. RESULTS: 101 subjects with decompensated cirrhosis met inclusion criteria; 97% were male with a median age of 60 years. The most common etiology of cirrhosis was due to hepatitis C virus. The overall incidence of at least one documented nutritional assessment conducted by a registered dietician (RD) was 69% (70/101). Approximately 41% of those patients evaluated by an RD were confirmed as being malnourished and had significant reductions in the dimensions of their gluteus maximus, erector spinae muscles and flank fat while their BMI and MELD scores were relatively unchanged over a 2-year period. Cirrhotic veterans that were not evaluated by an RD had similar reductions in fat and muscle mass compositions. Only 17% of malnourished subjects that were evaluated by an RD had a billing code (ICD-9 or ICD-10) in their medical record that corresponded to their malnutrition. CONCLUSION: Nearly one-third of U.S. veterans with decompensated cirrhosis had a documented diagnosis of malnutrition. There were significant reductions in skeletal muscle mass and fat mass over a 2-year time period that correlated with their chronic disease-related malnutrition. Interestingly, the presence or absence of an RD evaluation had no significant impact on these reductions. Corresponding ICD-9/ICD-10 billing codes associated with malnutrition were underreported, which may be a potential barrier in identifying and optimally treating malnutrition in U.S. veteran patients with decompensated cirrhosis.