Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a crucial type of liver failure with high prevalence in Asian continent.  Mounting evidence suggests that a direct association exists between HBV-ACLF and gastrointestinal barrier function. Nevertheless, the nutritional status of HBV-ACLF patients is yet not fully understood.

The current study evaluated the nutritional risk and nutritional status of HBV-ACLF patients and studied the influence of nutritional support on the gastrointestinal barrier and 28-d mortality. The researchers assessed nutritional risk screening and gastrointestinal barrier biomarkers of patients with HBV-ACLF (n = 234) and patients in the compensatory period of liver cirrhosis (the control group) (n = 234) during the duration between 2016 and 2018. The variations were determined after nutritional support in HBV-ACLF patients. Valuable biomarkers were analyzed to predict 28-d death. In addition, 28-d survival comparison was performed between HBV-ACLF patients with nutritional support or no nutritional support.

The results divulged that the nutritional risk of the HBV-ACLF patients was remarkably higher while nutritional intake of the patients with HBV-ACLF was lower in contrast to control group. The decrease in skeletal muscle and fat content and the deficiency of fat intake were observed. A rise in the coccus-bacillus ratio, secretory immunoglobulin A, and serum D-lactate was seen in HBV-ACLF patients. The survival group exhibited a lower nutritional risk, lower D-lactate, and cytokine levels such as endotoxin, tumor necrosis factor alpha, interleukin-10, and interleukin-1. Moreover, it was observed that interleukin-10 can be a predictor of death in HBV-ACLF patients. The nutritional support group had better 28-d survival in comparison to that of the non-nutritional support group.

Thus, it can be concluded that inadequate nutritional intake with high nutritional risk can be seen in patients with HBV-ACLF. In addition, the intestinal barrier function of these patients also get impaired. Thus, individualized and dynamic nutritional support is warranted for a better prognosis of 28-d mortality in HBV-ACLF patients.

Source: Chang Y, Liu QY, Zhang Q, Rong YM, Lu CZ, Li H. Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure. World J Gastroenterol. 2020;26(29):4288-4301.