PTU-111 Nutrition in cirrhosis: why we must save them from turning to (l)dust?

Abstract

IntroductionUndernutrition in cirrhotic patients is often poorly recognised until late-stage. The UK screening tool, the Malnutrition Universal Screening Tool, is flawed for patients with ascites/fluid retention. A 6-question Liver Disease Undernutrition Screening Tool (LDUST) has been developed and trialled on cirrhotic patients in America (1). It gave 72% sensitivity, 75% specificity and 93% positive predictive value for detecting undernutrition.MethodWe compared LDUST and MUST assessments for 50 inpatients and 50 outpatients and validated the inpatient scores against dietitian assessments.ResultsSimilar patient demographics and liver disease aetiology ratios were seen between the inpatients and the outpatients. Mean Child-Pugh scores were higher for inpatients (8.3 (SD1.9) vs 5.9 (SD1.2)). LDUST detected undernutrition in 45/50 inpatients (90%) and 34/50 outpatients (68%). MUST scores≥2 were present in 19/50 (38%) inpatients and 9/50 (18%) outpatients.In those with a MUST score <2, LDUST detected undernutrition in 26/31 (84%) inpatients and 27/41 (66%) outpatients. Of the 26 inpatients with LDUST undernutrition but MUST<2, 22 (85%) were referred to a dietician despite negative MUST screening. 2 were not reviewed due to refusal and end of life care. 20/22 referred were deemed to be undernourished and received either nasogastric feeding, or nutritional supplements. Thus 76% of patients deemed undernourished by LDUST, but not by MUST, were deemed to be suffering from malnutrition, but 100% of patients actually reviewed were malnourished according to dietetics assessment.LDUST could mostly be completed independently or with minimal assistance (80% inpatients and 100% outpatients), with mean completion times of 4 and 3 min for in and outpatients respectively.ConclusionLDUST is a quick and easy screening tool, which appears better able to detect undernutrition in cirrhotic patients than MUST and is validated against dietitian assessments. It appears to benefit both in and outpatients with increased detection of undernutrition missed by MUST. The high rates of undernutrition in inpatients with cirrhosis suggest that screening in this cohort may be unnecessary, and instead all should be reviewed by a dietitian. LDUST appears best utilised in an outpatient setting to detect malnutrition at an earlier stage.Reference. Booi AN, Menendez J, Norton HJ, Anderson WE, Ellis AC. Validation of a Screening Tool to Identify Undernutrition in Ambulatory Patients With Liver Cirrhosis. Nutr Clin Pract. 2015Oct;30(5):683–9.Disclosure of InterestNone Declared