Validation of a Screening Tool to Identify Undernutrition in Ambulatory Patients With Liver Cirrhosis

Booi, Amy N.; Menendez, Javier A.; Norton, H. James; Anderson, William E.; Ellis, Amy

doi:10.1177/0884533615587537

Cited by 39 publications

(31 citation statements)

References 16 publications

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“…In the original study in which RFH-NPT was developed, the diagnostic performance of the tool against malnutrition as diagnosed by the Royal Free Hospital Global Assessment tool was similar with the present study (100 % sensitivity and 73 % specificity) (11) . Accordingly, LDUST showed 72 % sensitivity and 75 % specificity in detecting undernutrition as identified by a registered dietitian in the original study who developed and validated the tool (10) ; thus its diagnostic performance was further and more strongly validated in the present study. RFH-NPT is completed by the healthcare specialist, while LDUST is self-completed by the patient.…”

Section: Discussionmentioning

confidence: 65%

“…the Malnutrition Universal Screening Tool (MUST) (20) , the Nutritional Risk Index (NRI) (21) , the Malnutrition Screening Tool (MST) (22) , the Nutritional Risk Screening (NRS-2002) (23) , the Birmingham Nutritional Risk Score (BNR) (24) and the Short Nutritional Assessment Questionnaire (SNAQ) (25) ). The other two were specifically designed for patients with advanced liver disease, namely the RFH-NPT (11) and the LDUST (10) . To certify the adequacy of translation for the three self-completed questionnaires (MST, SNAQ and LDUST), before handing them to any patient, they were translated by two independent translators into the Greek language and then back-translated into English.…”

Section: Nutrition Risk Screening Toolsmentioning

confidence: 99%

“…Both publications suggest that an initial rapid screening tool should be implemented to all cirrhotic patients, and those identified at risk for malnutrition should be referred for a detailed nutritional assessment. So far, there are only two nutritional screening tools developed especially for liver disease patients, namely the Liver Disease Undernutrition Screening Tool (LDUST) (10) and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) (11) . However, further validation is needed for these two tools in different populations, as acknowledged both by EASL and the European Society for Clinical Nutrition and Metabolism (ESPEN) (9,12) .…”

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confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 65%

Section: Nutrition Risk Screening Toolsmentioning

confidence: 99%

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confidence: 99%

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

et al. 2019

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“…Only three studies reported the use of NSTs in patients with cirrhosis . Booi et al published a three‐phase study to develop and internally validate a liver cirrhosis‐specific NSTtermed the ‘Liver Disease Undernutrition Screening Tool’ . Compared to a detailed dietician assessment it had a 72% sensitivity and 75% specificity for predicting malnutrition in a group of outpatients.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

Ney

Vandermeer

et al. 2019

Liver International

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Background & Aims Disease‐related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta‐analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. Methods The primary outcome measures were pre‐ and post‐transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test‐based NATs or lack of screening, assessment or outcome criteria. Results Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty‐two definitions for malnutrition were utilised across studies. NATs predicted pre‐transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96‐2.89). NATs were prognostic for post‐transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51‐6.12). Conclusions The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre‐transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut‐points for nutrition screening and assessment in cirrhosis.

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“…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.…”

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confidence: 99%

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

et al. 2017

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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

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Validation of a Screening Tool to Identify Undernutrition in Ambulatory Patients With Liver Cirrhosis

Cited by 39 publications

References 16 publications

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

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

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

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

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