Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria

BackgroundMalnutrition is highly prevalent and associated with complications and mortality in patients with cirrhosis.MethodsThis was a prospective observational study. Patients with cirrhosis were screened using the Nutritional Risk Screening 2002, the Royal Free Hospital-Nutritional Prioritizing Tool and the Skeletal Muscle Index. Then, the sensitivity, specificity, positive and negative predictive values, and consistency with the Global Leadership Initiative on Malnutrition criteria results were calculated. We also analysed the association between nutritional status and short-term prognosis.ResultsWe enrolled 125 patients with cirrhosis, of whom 59.20% and 60.00% were malnourished based on the Global Leadership Initiative on Malnutrition criteria and Skeletal Muscle Index. Some 53.60% and 65.60%, respectively, were classified medium-to-high nutritional risk by Nutritional Risk Screening 2002 and the Royal Free Hospital-Nutritional Prioritizing Tool. The Royal Free Hospital-Nutritional Prioritizing Tool had the best predictive value, and it was more sensitive and had a better negative predictive value than the Nutritional Risk Screening 2002 Tool. The Skeletal Muscle Index also had good sensitivity and predictive value. The Royal Free Hospital-Nutritional Prioritizing Tool, Skeletal Muscle Index and Global Leadership Initiative on Malnutrition criteria showed high concordance. The 3- and 6-month mortality rates were significantly higher for patients with moderate-to-high nutritional risk or malnutrition, regardless of the tool.ConclusionsWhen assessing cirrhosis with the Global Leadership Initiative on Malnutrition criteria, the Royal Free Hospital-Nutritional Prioritizing Tool is best for nutritional screening and the Skeletal Muscle Index is also a good nutritional assessment tool. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a better nutritional risk screening tool than the Nutritional Risk Screening 2002 for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition consensus for diagnosing malnutrition. The RFH-NPT is more valuable for determining the short-term prognosis of patients with liver cirrhosis.Key pointsimage Diagnosis and treatment of liver diseases were considered.The Royal Free Hospital-Nutritional Prioritizing Tool score is not affected by the presence of oedema and ascites and is therefore more advantageous than the Nutritional Risk Screening 2002, which is more commonly used in clinical practice in cirrhotic patients.The results of the present study show that the Royal Free Hospital-Nutritional Prioritizing Tool is more valuable than the Nutritional Risk Screening 2002 for determining the short-term prognosis of patients with liver cirrhosis.The study found good concordance between the Skeletal Muscle Index (SMI) and Global Leadership Initiative on Malnutrition criteria in patients with cirrhosis. Therefore, lumbar 3-SMI can be used to assess the nutritional status of these patients.C-reactive protein, interleukin-6 and procalcitonin levels significantly increased in patients with moderate-to-high nutritional risk or malnutrition compared to their counterparts.