Introduction Patients with cirrhosis are frequently malnourished and this has a detrimental effect on outcome in terms of complications, survival after liver transplantation and overall liver-related mortality. The detection of malnutrition and its active management is, therefore, pivotal to these patients' well-being and survival. The aim of this study was to design and develop a simple, nutritional screening tool for use in patients with cirrhosis -The Royal Free Nutritional Prioritising Tool (RFH-NPT)—and to validate its use against the Royal Free Hospital Global Assessment (RFH-GA) which is the accepted gold standard for nutritional assessment of cirrhotic patients in the UK.
Methods The RFH-NPT was devised and piloted; interobserver performance agreement was excellent. Validation was undertaken in a cohort of patients with cirrhosis on transplant units throughout the UK and Southern Ireland. Patients' nutritional status was determined and categorised, by nursing staff, using the RFH-NPT (completion time 3 min). The results were compared with the categorisation of nutritional status determined by dietitians using the RFH-GA (completion time 45 min). The analysis of descriptive data, cross-tabulation, performance variables, 95% CIs and κ values were calculated using standard methods. κ Values were interpreted according to Altman, 1999.
Results The patient population comprised 133 patients with cirrhosis (98 men: 35 women; mean [range] age 56 [23–73] yr). Overall 49 (37 %) patients were classified, using the RFH-GA, as adequately nourished; 46 (35%) as moderately malnourished and 38 (29%) as severely malnourished. The RFH-NPT identified patients who were at high risk for malnutrition with a diagnostic sensitivity of 100% (95% CI 89 to 100) and specificity of 73% (95% CI 63 to 81) (κ value 0.41, 95% CI 29 to 53).
Conclusion The RFH-NPT is a simple, quick and validated method for identifying patients with cirrhosis who at high risk for malnutrition. Further multicentre validation is warranted.
Competing interests None declared.
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