The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis

Borhofen, Sarah Maria; Gerner, Carmen; Lehmann, Jennifer; Fimmers, Rolf; Görtzen, Jan; Hey, Beate; Geiser, Franziska; Strassburg, Christian P.; Trebicka, Jonel

doi:10.1007/s10620-015-4015-z

Cited by 121 publications

(130 citation statements)

References 15 publications

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“…Importantly, the Malnutrition Universal Screening Tool (recommended by ESPEN as the preferred screening tool for outpatients) is incorporated within the RFH‐NPT in patients who do not have fluid overload. In a series of 148 patients, the RFH‐NPT was identified as an independent predictor of clinical deterioration and transplant‐free survival . The content validity of this tool in a population with cirrhosis is promising and encompasses features of clinical and metabolic risk, along with classical nutritional variables that may influence response to nutrition therapy.…”

Section: Which Nutrition Screening/nutrition Risk Tool(s) Can Be Usedmentioning

confidence: 99%

A practical approach to nutritional screening and assessment in cirrhosis

Tandon

Raman

Mourtzakis³

et al. 2017

Hepatology

236

251

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Malnutrition is one of the most common complications of cirrhosis, associated with an increased risk of morbidity and mortality. As a potentially modifiable condition, it is of particular importance to identify malnourished patients so that nutritional therapy can be instituted. Nutrition screening and assessment are infrequently performed in patients with cirrhosis. The reasons for this are multifactorial, including the absence of a validated "rapid" screening tool, multiple definitions of what constitutes malnutrition, and challenges with interpreting body composition and laboratory results in the setting of volume overload and liver dysfunction. This article summarizes the clinically relevant evidence and presents key issues, tools, and clinical options that are applicable to patients with cirrhosis. The definition, etiology, and clinically relevant outcomes associated with malnutrition are reviewed. Rapid nutritional screening is differentiated from more detailed nutritional assessment. Nutritional assessment in special populations, including women and the obese, and the role of inflammation are discussed. Multicenter studies using a common nutritional screening/assessment strategy are the next steps to fast-track adoption and implementation of nutrition-related evaluations into routine clinical practice. (Hepatology 2017;65:1044-1057).

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Section: Which Nutrition Screening/nutrition Risk Tool(s) Can Be Usedmentioning

confidence: 99%

A practical approach to nutritional screening and assessment in cirrhosis

Tandon

Raman

Mourtzakis³

et al. 2017

Hepatology

236

251

View full text Add to dashboard Cite

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“…Finally, the overall risk score was calculated, which directed the appropriate nutritional management. This scoring system was validated in other studies and has good reproducibility . The RDs used the RFH‐NPT in the prospective arm to prioritize patients at a greater risk for nutritional compromise and to ensure that they were given nutritional supplement recommendations.…”

Section: Methodsmentioning

confidence: 99%

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions

et al. 2019

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Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. We aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90‐day readmissions. This study was conducted in 2 phases. Retrospectively, records of hospitalized patients with cirrhosis from the university and Veterans Affairs Medical Center (VAMC) settings were reviewed to assess nutritional status, if a nutrition consultation occurred, the number of days patients were nil per os (npo) and received inadequate nutrition, and if nutritional management was guideline directed. In the prospective phase, after dedicated educational efforts directed at the stakeholders regarding nutritional guidelines for patients with cirrhosis, subsequently hospitalized cirrhosis patients had nutritional and 90‐day readmission data collected for comparison between groups. In total, 279 patients were included in the retrospective phase (150 university/129 VAMC), and 102 VAMC patients were in the prospective phase. Cirrhosis severity, reason for admission, and hospital course were similar between groups regardless of cohort, ie, prospective versus retrospective or VAMC versus university. The prospective group had significantly more nutritional consultations and assessments (74.5% versus 40.1%; P < 0.001) compared with the retrospective group regardless of comparisons between the VAMC and university cohorts. Both groups had a similar number of days npo, but the prospective group had fewer days of inadequate nutrition. The 90‐day readmission rate was significantly lower in the prospective group versus the retrospective group (39.4% versus 28.4%; P = 0.04), which was associated with greater nutrition outpatient follow‐up. In conclusion, nutritional consultation rates in inpatients with cirrhosis can be significantly improved after educational intervention and is associated with lower 90‐day readmission rates.

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“…Protein caloric malnutrition is described as the gradual loss of both lean body mass (protein) and adipose tissue (calorie), coexisting with the expansion of extracellular mass [1, 2]. Several pathomechanisms participate in the development of malnutrition in cirrhotic patients, for example, anorexia followed by inadequate oral ingestion, nausea, vomiting, early satiety, and side effects of administered drugs.…”

Section: Malnutrition In the Course Of Liver Cirrhosis And Methodsmentioning

confidence: 99%

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

Cichoż‐Lach

Michalak

2017

Gastroenterology Research and Practice

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It is assumed that approximately 24–66% of patients with liver cirrhosis develop malnutrition. Numerous pathological processes lead to serious disorders of nutritional status in this group of patients. Malnutrition in the course of liver cirrhosis is associated with increased morbidity, complications, and low quality of life. Under these conditions, detection of malnutrition is of crucial importance. This review explores the complex mechanisms that lead to malnutrition in the course of liver cirrhosis and focuses on methods used in the assessment of nutritional status in cirrhotic patients. Among others, the role of bioelectrical impedance is highlighted. This noninvasive tool is promising and quite an accurate method of estimating body composition.

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The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis

Abstract: 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.

Cited by 121 publications

References 15 publications

A practical approach to nutritional screening and assessment in cirrhosis

A practical approach to nutritional screening and assessment in cirrhosis

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

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