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

Yuchao Wu,Huan Liu,Ruojing Wang,Yage Zhu,Yali Feng,Yingren Zhao,Naijuan Yao,Yuan Yang,Xiaohui Liu,Li Zhu,Mengmeng Zhang,Lei Shi,Jinfeng Liu,Hongmei Chen,Nan Yang

doi:10.1017/s0007114520002366

Abstract

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend the 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 the 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 co-morbid 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 malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of the RFH-NPT against the NRS-2002 (63 v. 51 %). The RFH-NPT tended more easily to detect malnutrition risk in patients with advanced Child-Pugh classes (B and C) and lower Model for End-stage Liver Disease scores (<15) compared with NRS-2002. 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 low risk; the same result was not obtained with the NRS-2002. Therefore, we suggest that using the 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.

Highlights

Malnutrition is a very common and serious complication of cirrhosis, with a prevalence ranging from 60 to 85 %(1–4)
Among those with hepatitis virus-related cirrhosis, 59·4 % (92/155) of the patients were infected with hepatitis B virus (HBV), and 30·3 % (47/155) were infected with hepatitis C virus (HCV)
We investigated whether the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) or the NRS-2002 was more sensitive for the identification of the risk of malnutrition risk at a relatively early stage of liver cirrhosis according to the Child– Pugh class

Summary

Introduction

Malnutrition is a very common and serious complication of cirrhosis, with a prevalence ranging from 60 to 85 %(1–4). The onset and/or severity of malnutrition proceeds from a compromised nutritional state to an obvious loss of weight and to a lean body mass It is associated with the progression of liver dysfunction[5] but is related to complications of liver cirrhosis, such as infections, hepatic encephalopathy and ascites[6,7]. The RFH-NPT was first developed in a multicentre trial in the UK to detect nutritional status in patients with chronic liver disease[13] It is applied in the clinical setting, which enables even non-specialist staff to efficiently utilise the tool, saving time. The NRS-2002 is another simple tool primarily based on the indications for nutritional support in 2002(14) 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]. We investigated whether the assessment of the risk of malnutrition by the RFH-NPT was still superior to assessment with the NRS-2002 in China by comparing them with the results obtained with the Royal Free Hospital-Global Assessment (RFH-GA)

Methods

Results

Discussion

Conclusion