The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis
Background and Aims
Malnutrition might affect survival and severity of complications in cirrhotic patients. However, adequate evaluation of the nutritional status is a difficult task since the common assessment tools are either inappropriate or too complicated. A simpler method could evaluate the patient’s risk for malnutrition instead of the nutritional status itself. This study evaluated the prediction of clinical deterioration and transplant-free survival in patients with chronic liver disease by two nutritional risk scores.
In 84 cirrhotic patients, Nutritional Risk Screening (NRS), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), and the chronic liver disease questionnaire have been assessed. These patients were evaluated at a second time point after a median observation time of 500 days. Another cohort of 64 patients was collected to validate the findings.
Of the included patients, 67.7 % were male with a median age of 57 years and a median Child score of 9. RFH-NPT classified 50.7 % of the patients as high-risk patients, and NRS assessed 44.6 % of the patients as moderate- to high-risk patients. RFH-NPT correlated with clinical deterioration, severity of disease (Child score, MELD score), and clinical complications such as ascites, hepatorenal syndrome, and episodes of hepatic encephalopathy. RFH-NPT was an independent predictor of clinical deterioration and transplant-free survival. Furthermore, improvement in RFH-NPT within 500 days was associated with improved survival.
Assessing the patients’ risk for malnutrition by RFH-NPT may be a useful predictor of disease progression and outcome for patients with chronic liver disease.
KeywordsCirrhosis Nutritional assessment CLDQ NRS RFH-NPT
Body mass index
Chronic liver disease questionnaire
Health-related quality of life
Model for end-stage liver disease
Nutritional Risk Screening
Primary sclerosing cholangitis
Royal Free Hospital-Nutritional Prioritizing Tool
Royal Free Hospital-Global Assessment
Receiver operating characteristic
Spontaneous bacterial peritonitis
Subjective global assessment
JT is supported by Deutsche Forschungsgemeinschaft (SFB TRR57), H. J. & W. Hector Stiftung (M60.2), Ernst-Bertha-Grimmke-Stiftung (6/15), and European Union’s Horizon 2020 research and innovation program (No. 668031).
Compliance with ethical standards
Conflict of interest
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