A comparative study of malnutrition screening tools in advanced liver disease: Sensitivity, specificity, and patient acceptability

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-06-05 DOI:10.1016/j.clnesp.2025.06.003

Shaye Ludlow , Emmah McKeown , Kelly Squires , Sarah Pullen , Paulett Barnes , Alison Gibberd , Lucy Leigh , John Attia , Katie Wynne

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引用次数: 0

Abstract

Background

Patients with advanced liver disease (ALD) are at increased risk of malnutrition, significantly impacting patient outcomes and quality of life. Screening for malnutrition in ALD can be challenging with changes in weight potentially concealed by fluid from ascites and oedema, or muscle wasting. Current validated malnutrition screening tools used in ALD account for physiological symptoms, but there are no known validated tools that also screen for non-physiological symptoms or fluid overload.

Aim

To examine the sensitivity and specificity of a novel malnutrition screening tool for adults with ALD, (Child-Pugh score B or C) with or without ascites attending a regional and metropolitan health site, against three established malnutrition screening tools compared with a Subjective Global Assessment (SGA) as the reference standard.

Methods

A cross-sectional study was undertaken within the outpatient and inpatient hepatology services of a metropolitan and a regional hospital. Each participant completed four malnutrition screening tools, the Patient Generated Subjective Global Assessment Short Form (PG-SGA SF), Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT), Malnutrition Screening Tool (MST), and a newly developed novel screening tool (Nutrition-ALD) as well as a diagnostic SGA with the dietitian. Performance of each tool was compared by calculating sensitivity, specificity, and area under the curve (AUC). Wellbeing scores measured by Integrated Palliative care Outcome scale (IPOS) were correlated with the malnutrition screening tool scores.

Results

50 participants with Child-Pugh B and C liver disease [n = 33 (66 %) outpatient setting; n = 17 (34 %) inpatient setting] were recruited for this study. 82 % of participants were diagnosed with mild to moderate or severe malnutrition using SGA. Relative to the SGA, the PG-SGA SF had the highest AUROC, followed by the novel screening tool. PG-SGA SF demonstrated the highest sensitivity (0.88) and specificity (0.89). Participant-reported experience was most favourable for the novel screening tool, followed by PG-SGA SF.

Conclusion

A nutrition screening tool should be quick, sensitive, and specific to detect malnutrition risk to allow for early nutrition intervention. In this study population, the PG-SGA SF had the highest sensitivity and specificity, and the novel tool was most acceptable to the participants. Consideration of wellbeing with a holistic and supportive approach to malnutrition screening may improve accuracy and timeliness of referrals for patients requiring nutrition support and improve efficiency in low-resource settings.

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晚期肝病营养不良筛查工具的比较研究：敏感性、特异性和患者可接受性。

背景：晚期肝病（ALD）患者营养不良的风险增加，显著影响患者的预后和生活质量。筛查ALD患者的营养不良可能具有挑战性，因为体重变化可能被腹水、水肿或肌肉萎缩所掩盖。目前用于ALD的经验证的营养不良筛查工具考虑了生理症状，但还没有已知的经验证的工具也筛查非生理症状或液体超载。目的：研究一种新的营养不良筛查工具的敏感性和特异性，用于在区域和大都市健康站点就诊的伴有或不伴有腹水的成年ALD患者（Child-Pugh评分B或C），与三种已建立的营养不良筛查工具进行比较，并将主观总体评估（SGA）作为参考标准。方法：横断面研究进行了门诊和住院肝病服务的一个大城市和地区医院。每位参与者完成了四种营养不良筛查工具，即患者生成主观总体评估简短表（PG-SGA SF）、皇家自由医院营养优先排序工具（RFH-NPT）、营养不良筛查工具（MST）和新开发的新型筛查工具（Nutrition- ald），以及由营养师进行的诊断性SGA。通过计算灵敏度、特异度和曲线下面积（AUC）来比较每种工具的性能。综合姑息治疗结果量表（IPOS）测量的健康得分与营养不良筛查工具得分相关。结果：50名儿童Pugh B和C型肝病患者[n=33（66%）门诊；N =17（34%）住院患者]被纳入本研究。82%的参与者使用SGA被诊断为轻度至中度或重度营养不良。相对于SGA， PG-SGA SF的AUROC最高，其次是新型筛选工具。PG-SGA SF具有最高的敏感性（0.88）和特异性（0.89）。参与者报告的经验最有利于新型筛查工具，其次是PG-SGA SF。结论：营养筛查工具应快速、灵敏、特异地发现营养不良风险，以便进行早期营养干预。在本研究人群中，PG-SGA SF具有最高的敏感性和特异性，并且这种新型工具最容易被参与者接受。考虑营养不良筛查的整体和支持性方法的健康，可以提高需要营养支持的患者转诊的准确性和及时性，并提高低资源环境下的效率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.