Comprehensive nutritional management incorporating home-based dietary consultation improves hepatic encephalopathy in cirrhotic patients: a retrospective cohort study

Few studies have clinically demonstrated the benefits of comprehensive nutritional management incorporating home-based dietary consultation in patients with cirrhosis. This study investigates whether such management can improve the prognosis of cirrhotic patients. This retrospective study included 260 cirrhosis patients hospitalized between May 2022 and August 2023. We compared baseline characteristics and adverse outcomes during follow-up between patients who received comprehensive nutritional management incorporating home-based dietary consultation (nutritional management group) and those who did not (usual care group). Kaplan-Meire analysis was applied to compare the liver transplant-free survival rate and the cumulative overt hepatic encephalopathy (OHE)-free rate between groups. Univariate and multivariate Cox regression models were performed to identify clinical factors associated with prognosis. The incidence of OHE was significantly lower in the comprehensive nutritional management group compared to the usual care group. Kaplan–Meier analysis demonstrated a considerably higher cumulative OHE-free rate in the nutritional management group (log-rank P = 0.001). However, the two groups had no significant difference in liver transplant-free survival. Multivariate Cox regression analysis identified nutritional management (HR 0.326, 95% CI: 0.150–0.712, P = 0.005) and higher serum albumin levels (HR 0.917, 95% CI: 0.855–0.983, P = 0.015) as protective factors against OHE, whereas sarcopenia (HR 2.541, 95% CI: 1.297–4.977, P = 0.007) and elevated serum ammonia levels (HR 1.009, 95% CI: 1.000–1.018, P = 0.043) were associated with increased risk. However, comprehensive nutritional management was not significantly associated with mortality in Cox multivariate analysis. Implementing comprehensive nutritional management incorporating home-based dietary consultation is beneficial in reducing the risk of OHE in cirrhosis patients.