Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study

Abstract

Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.

Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002

“…When compared with the RFH-GA in our study, the LDUST had the highest sensitivity and lowest specificity (69 and 10 %, respectively), and the MUST had the lowest sensitivity (38•6 %). In addition, the present study showed that the RFH-NPT was better able than the LDUST to predict the risk of malnutrition associated with increased mortality (17) . Therefore, we did not consider the LDUST and MUST in the subsequent analyses, instead focusing on the NRS-2002, which is relatively more widely used in clinical practice in China, and the RFH-NPT.…”

“…The identification of patients at risk of malnutrition in a hospital setting with an effective and simple nutrition risk screening tool is essential; such a tool would enable earlier nutrition assessment and more timely interventions, leading to reductions in morbidity and mortality in patients with cirrhosis (6) . Previous European studies suggested that the RFH-NPT was more sensitive than the NRS-2002 for the assessment of the risk of malnutrition and the prediction of disease progression and outcomes in patients with chronic liver disease based on regression analysis (11,12,16,17) . Although the RFH-NPT is recommended as a screening tool for malnutrition in liver disease patients, there are few data from Asia.…”

“…In Europe, alcohol consumption is the primary cause of liver cirrhosis. A European study found that malnutrition is more prevalent in patients with alcoholic cirrhosis than in those with viral cirrhosis (17) . The RFH-NPT specially takes alcohol-related variables into consideration.…”

“…It combines several variables, including the percentage of weight loss, BMI, a reduction in food intake and the presence of disease and its severity (14,15) . A comparison suggested that the RFH-NPT was more sensitive than the NRS-2002 for the identification of liver patients at risk for malnutrition (16,17) . However, the studies regarding the use of the RFH-NPT to assess the risk of malnutrition in patients with liver disease were mainly performed in Europe (16,17) , where alcoholic liver disease is the primary aetiology of liver cirrhosis and there is a higher prevalence of malnutrition.…”

“…A comparison suggested that the RFH-NPT was more sensitive than the NRS-2002 for the identification of liver patients at risk for malnutrition (16,17) . However, the studies regarding the use of the RFH-NPT to assess the risk of malnutrition in patients with liver disease were mainly performed in Europe (16,17) , where alcoholic liver disease is the primary aetiology of liver cirrhosis and there is a higher prevalence of malnutrition. In contrast, most cases of liver cirrhosis are due to viral hepatitis in China, rendering the evaluation of alcohol consumption in the RFH-NPT irrelevant in Chinese populations.…”