Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) Improves the Prediction of Malnutrition Risk Outcomes in Liver Cirrhosis Patients Compared with Nutritional Risk Screening 2002 (NRS-2002).

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) to identify malnutrition risk in patients with liver disease. However, little is known about the application of RFH-NPT to screen for the risk of malnutrition in China, where patients primarily suffer from hepatitis virus-related cirrhosis. A total of 155 cirrhosis patients without liver cancer or uncontrolled comorbid illness were enrolled in this prospective study. We administered the Nutritional Risk Screening 2002 (NRS-2002), RFH-NPT, Malnutrition Universal Screening Tool(MUST), and Liver Disease Undernutrition Screening Tool (LDUST) to the patients within 24 h after admission and performed follow-up observations for 1.5 years. The RFH-NPT and NRS-2002 had higher sensitivities (64.8% and 52.4%) and specificities (60% and 70%) than the other tools with regard to screening for the malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of RFH-NPT against the NRS-2002(63% vs. 51%). RFH-NPT tended more easily to detect the malnutrition risk in patients with advanced Child-Pugh classes (B and C) and lower MELD scores (<15) compared with NRS-2002. The RFH-NPT score was an independent predictive factor for mortality. Patients identified as being at high malnutrition risk with the RFH-NPT had a higher mortality rate than those at a low risk; the same result was not obtained with the NRS-2002. Therefore, we suggest that using RFH-NPT improves the ability of clinicians to predict malnutrition risk in patients with cirrhosis primarily caused by hepatitis virus infection at an earlier stage.