Article Text


Nutrition screening
PMO-040 The development and validation of a nutritional prioritising tool for use in patients with chronic liver disease
  1. S Arora1,
  2. C Mattina1,
  3. M Catherine2,
  4. N O'Sullivan3,
  5. L McGeeney4,
  6. C Nina4,
  7. G Gatiss4,
  8. B Davidson5,
  9. B Engel6,
  10. M Morgan7
  1. 1Royal Free Hampstead NHS Trust, London, UK
  2. 2Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3St. Vincent's Hospital, Dublin, Ireland
  4. 4Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  5. 5The Freeman Hospital, Newcastle, UK
  6. 6Surrey University, Guildford, UK
  7. 7Centre for Hepatology, Royal Free Campus, University College London Medical School, London, UK


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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