Abstract
BackgroundThe aim of the present study was to determine the extent of malnutrition in patients waiting for a liver transplant. The agreement among the methods of nutritional assessment and their diagnostic validity were evaluated.MethodsPatients on the waiting list for liver transplantation (n = 110) were studied. The variables were: body mass index, analytical parameters, liver disease etiology, and complications. Liver dysfunction was evaluated using the Child–Pugh Scale. Nutritional state was studied using the Controlling Nutritional Status (CONUT), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) criteria, the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (PNI-O), and the Subjective Global Assessment (SGA). Agreement was determined using the Kappa index. Area under receiver operator characteristic curves (AUCs), the Youden index (J), and likelihood ratios were computed.ResultsMalnutrition varied depending on the method of evaluation. The highest value was detected using the CONUT (90.9%) and the lowest using the SGA (50.9%). The pairwise agreement among the methods ranged from K = 0.041 to K = 0.826, with an overall agreement of each criteria with the remaining methods between K = 0.093 and K = 0.364. PNI-O was the method with the highest overall agreement. Taking this level of agreement into account, we chose the PNI-O as a benchmark method of comparison. The highest positive likelihood ratio for the diagnosis of malnutrition was obtained from the Nutritional Risk Index (13.56).ConclusionsMalnutrition prevalence is high and prevalence estimates vary according the method used, with low concordance among methods. PNI-O and NRI are the most consistent methods to identify malnutrition in these patients.
Highlights
The presence of protein-calorie malnutrition is common among patients with liver disease
We aimed to determine the malnutrition degree in patients on the liver transplant list, study the concordance among assessment methods, and explore the diagnostic validity compared to a benchmark that was chosen because it obtained the best overall concordance
Prevalence of malnutrition according to the degree of liver dysfunction
Summary
The presence of protein-calorie malnutrition is common among patients with liver disease. Great variability in the prevalence of malnutrition has been observed, depending on the method used for assessment[5] and on the severity of the disease, which can change the body composition and analytical parameters.[6] there is no consensus among authors on which are the most effective methods to assess the nutritional state of these patients. The aim of the present study was to determine the extent of malnutrition in patients waiting for a liver transplant. Methods: Patients on the waiting list for liver transplantation (n 1⁄4 110) were studied. PNI-O was the method with the highest overall agreement. The highest positive likelihood ratio for the diagnosis of malnutrition was obtained from the Nutritional Risk Index (13.56). PNI-O and NRI are the most consistent methods to identify malnutrition in these patients
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