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

Abstract

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) to identify malnutrition risk in patients with liver disease. However, little is known about the application of RFH-NPT to screen for the risk of malnutrition in China, where patients primarily suffer from hepatitis virus-related cirrhosis. A total of 155 cirrhosis patients without liver cancer or uncontrolled comorbid illness were enrolled in this prospective study. We administered the Nutritional Risk Screening 2002 (NRS-2002), RFH-NPT, Malnutrition Universal Screening Tool(MUST), and Liver Disease Undernutrition Screening Tool (LDUST) to the patients within 24 h after admission and performed follow-up observations for 1.5 years. The RFH-NPT and NRS-2002 had higher sensitivities (64.8% and 52.4%) and specificities (60% and 70%) than the other tools with regard to screening for the malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of RFH-NPT against the NRS-2002(63% vs. 51%). RFH-NPT tended more easily to detect the malnutrition risk in patients with advanced Child-Pugh classes (B and C) and lower MELD scores (<15) compared with NRS-2002. The RFH-NPT score was an independent predictive factor for mortality. Patients identified as being at high malnutrition risk with the RFH-NPT had a higher mortality rate than those at a low risk; the same result was not obtained with the NRS-2002. Therefore, we suggest that using RFH-NPT improves the ability of clinicians to predict malnutrition risk in patients with cirrhosis primarily caused by hepatitis virus infection at an earlier stage.

Muscular abnormalities in liver cirrhosis

“…It includes three major steps: (1) Patients who have alcoholic hepatitis or are undergoing tube feeding are immediately evaluated as high risk without proceeding to the next step; (2) Patients who do not have alcoholic hepatitis and are not undergoing tube feeding are assessed for fluid overload and its impact on food intake and weight loss; and (3) Patients who do not have fluid overload are assessed for nutritional status (BMI, unplanned weight loss, and daily dietary intake). Patients are stratified as being at low, moderate, or high risk[ 2 , 25 ].…”

“…The MUST includes three categories: Current BMI, unintentional weight loss, and the presence of any acute disease that could compromise nutritional intake for more than 5 d[ 25 ].…”

“…The questionnaire proved to be useful in the group of patients with a low MELD score and for assessing the prognosis of the disease. The disadvantage of the study is that different questionnaires are only compared with each other, and with only basic laboratory and anthropometric parameters[ 25 ]. In a recent publication, Buchard et al [ 5 ] noted that RFH-NPT and LDUST, despite recommendations for their use in patients with liver cirrhosis, have not yet been associated with clinical issues such as survival and complications appearance.…”

“…According to EASL guidelines, two simple criteria can be used in everyday clinical practice to stratify patients at high risk of malnutrition: being underweight (BMI < 18.5 kg/m 2 ) and having advanced decompensated cirrhosis (Child C patients)[ 28 ]. In patients with ascites and peripheral edema, dry weight assessment is proposed, either estimated by the post paracentesis body weight, the weight recorded before fluid retention if available, or by subtracting a percentage of weight based upon the severity of ascites (mild 5%; moderate 10%; severe 15%), with an additional 5% subtracted if bilateral peripheral edema is present[ 25 , 28 ].…”

Frailty in Liver Transplantation: A Comprehensive Review

“…Instruments include a subjective global assessment (SGA) [25] and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). [26] Several methods to evaluate nutritional risk and assess nutritional status are provided in Table 1. Anthropometric testing can also be utilized, including measurement of the triceps skin fold, mid-upper arm circumference, and handgrip strength.…”