Malnutrition and immuno-incompetence in patients with liver disease.

The incidence of malnutrition and immunocompetence in 156 patients admitted to hospital with liver disease was investigated. Expected weight/height was within the normal range for all groups except those with carcinoma. Triceps skinfold thickness (TSF) was reduced in 49% of patients with cirrhosis and 55% with alcoholic disease. Hypoalbuminaemia was common in all groups, with 66% of those with chronic disease having concentrations below 35 g/dl. Lymphopenia was equally common, 65% of patients with fulminant hepatic failure (FHF) having counts below 1000 cells/mm3. Incidence of total anergy to standard skin tests was 54% overall: 93% in FHF and 60% in cirrhosis and alcoholic disease. There were significant links between reduced TSF and hypoalbuminaemia, lymphopenia and anergy, hypoalbuminaemia and anergy, and anergy and mortality. Reduced TSF was only associated with anergy in patients with chronic disease. The high incidence of immuno-incompetence may underlie the frequent occurrence of spontaneous infections in patients with liver disease, and the association between anergy and malnutrition in patients with chronic liver disease suggests that the anergy may be partly reversible by dietary measures.