Comparison of the Performance of Existing Nutritional
Screening Tools against Subjective Global Assessment in
Cirrhotic Patients
Piyanant Chonmaitree MD¹, Asawin Sudcharoen MD¹, Piyakorn Poonyam MD¹, Worawut Roongsangmanoon MD¹,
Kitsarawut Khuancharee PhD², Nutthawut Laoarphasuwong MD¹
Affiliation : ¹ Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak Campus, Nakhon Nayok, Thailand ² Department of Preventive and Community Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak Campus, Nakhon Nayok, Thailand
Background: Malnutrition in cirrhosis has a significant negative impact on morbidity and mortality. There is no agreed gold standard of the screening tool.
Study comparing the diagnostic properties of nutritional assessment tools in cirrhotic patients is limited. The Subjective Global Assessment (SGA) is one of
the global assessment tools. It is used to assess nutritional status in different patient populations.
Objective: To evaluate the diagnostic properties of different nutritional screening tools compared with SGA in cirrhotic patients.
Materials and Methods: A cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center. All cirrhotic patients were enrolled. The nutritional status was evaluated by the SGA, the Royal Free Hospital Subjective Global Assessment (RFH-SGA), the Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST), the Malnutrition Universal Screening Tool (MUST), the Prognostic Nutritional Index (PNI-O), the Nutritional Risk Index (NRI), the Spanish Society of Parenteral, the Enteral Nutrition (SENPE), and the Controlling Nutritional Status (CONUT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate RFH-SGA, RFH-NPT, LDUST, MUST, PNI-O, NRI, SENPE, and CONUT compared with SGA.
Results: Ninety-four cirrhotic patients were included. The mean age was 60.82 (SD 10.11) years. Patients with cirrhosis Child Turcotte Pugh (CTP) A, B, and C were 62, 21, and 11, respectively. Twenty-five patients (28.7%) were malnourished according to SGA, five with CTP A cirrhosis, twelve with CTP B cirrhosis, and ten with CTP C cirrhosis. The present study also showed that NRI had the highest sensitivity (100%) and LDUST had the highest specificity (94%).
Conclusion: NRI is an effective tool with high sensitivity for identifying malnutrition in early stage of cirrhosis.
Received 4 May 2021 | Revised 7 July 2021 | Accepted 12 July 2021
doi.org/10.35755/jmedassocthai.2021.08.12854
Keywords :
Nutritional screening; Cirrhosis; Subjective Global Assessment; SGA; Nutritional Risk Index; NRI
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