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