ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicNutritional Status and Nutritional Support in Hospitalized PatientsView all 24 articles
Adjuvant nutritional support for patients with acute-on-chronic liver failure reduce the risk of clinical complications
Provisionally accepted
- 1Interventional Therapy Center, West China Hospital, Sichuan University, Chengdu, China
- 2West China Hospital, Sichuan University, Chengdu, China
- 3West China School of Nursing, Sichuan University, chengdu, China
- 4Interventional Ward, West China Hospital, Sichuan University, Chengdu, China
- 5Department of General Surgery, Division of Gastrointestinal Surgery, West China Hospital, Sichuan University, Cheng, China
- 6Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
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Abstract Background: Acute-on-chronic liver failure (ACLF) patients face high risks of nutritional risk and clinical complications, but whether adjuvant nutritional support reduces adverse complications remains unclear. Methods: This study included 6,097 hospitalized ACLF patients at West China Hospital. The Nutrition Risk Screening (NRS 2002) was used to assess the nutritional risk of the patients. Additional personalized enteral or parenteral nutrition was provided. The Kruskal-Wallis test and chi-square test compared continuous and categorical variables. Multivariate logistic regression analyzed odds ratios (ORs) and 95% confidence intervals (95% CI) for nutritional intervention and adverse outcomes, while the Cox model evaluated all-cause mortality risk. Results: Among participants (median age 53 years, 69.2% male), 52.5% (3,201) had nutritional risk, who were older, had lower body mass index (BMI), longer hospital stays, and higher rates of infection, hepatorenal syndrome, hepatic encephalopathy, coagulation disorders, and mortality (P<0.01). After confounding adjustment, nutritional intervention in high-risk patients was associated with lower frequency of ascites (OR=0.50, 95% CI: 0.31–0.80), infection (OR=0.70, 95%CI: 0.52–0.94), and spontaneous bacterial peritonitis (SBP) (OR=0.34, 95%CI: 0.24–0.49). Moreover, for patients without nutritional risk, nutritional intervention was also associated with lower frequency of ascites [0.26 (0.12-0.55)], SBP [0.30 (0.17-0.54)], and coagulation disorder [0.35 (0.17-0.72)]. Subgroup analysis showed consistent conclusions in most subgroups. However, nutritional intervention had no significant effect on improving all-cause mortality. Conclusion: Over half of liver failure patients have nutritional risk. Adjuvant nutritional support was associated with significantly lower frequencies of clinical complications, especially ascites and SBP, regardless of nutritional risk.
Keywords: Acute-on-chronic liver failure, complication, NRS 2002, nutrition risk assessment, Nutritional intervention
Received: 28 Oct 2025; Accepted: 22 Dec 2025.
Copyright: © 2025 Ma, Qiu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hong Liu
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