GLIM标准下3种营养筛查工具对肝硬化患者的适用性分析

Applicability of three nutritional screening tools in patients with liver cirrhosis under the Global Leadership Initiative on Malnutrition criteria

目的探讨皇家自由医院-营养优先排序工具(RFH-NPT)与营养风险筛查2002(NRS2002)哪项更适合肝硬化患者的营养风险筛查,探讨主观全面营养评定(SGA)在肝硬化患者营养评估中的适用性。方法选取2020年8月—2021年6月在武汉大学人民医院住院的113例肝硬化患者,应用RFH-NPT和NRS2002进行营养风险筛查,应用SGA进行营养评估,将结果与全球(营养)领导层倡议营养不良(GLIM)诊断标准进行比较,分别计算出3种工具的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)。分别绘制3种筛查工具的受试者工作特征曲线(ROC曲线),并计算曲线下面积(AUC)。分析患者营养状况与短期预后的关系。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验。NRS2002、RFHNPT、SGA与GLIM标准的相关性采用Spearman秩相关进行分析。结果GLIM标准下有69.9%的患者被诊断为营养不良,RFH-NPT和NRS2002分别筛查出72.6%和51.3%的患者存在营养风险,SGA评估下有57.5%的患者为营养不良。与NRS2002相比,RFH-NPT与GLIM标准具有更高的相关性(r=0.764,P<0.001),更高的敏感度(94.9%)和NPV(87.1%),且具有更好的预测价值(AUC=0.872,95%CI:0.786~0.957)。GLIM标准下,SGA诊断肝硬化患者营养不良的特异度较高(88.2%),敏感度一般(77.2%),具有良好的相关性(r=0.607,P<0.001)和预测价值(AUC=0.827,95%CI:0.744~0.911)。GLIM标准、SGA、RFH-NPT评估下,营养风险或营养不良患者的住院时间更长(Z值分别为-3.301、-2.812、-3.813,P值均<0.05),再住院率更高(χ^(2)值分别为3.957、6.922、6.766,P值均<0.05)。GLIM标准、NRS2002评估下有营养风险或营养不良的患者3个月内病死率明显增加(χ^(2)值分别为4.511、0.776,P值均<0.05)。结论GLIM标准下,RFH-NPT比NRS2002更适合肝硬化患者的营养风险筛查,SGA在肝硬化患者的营养评估中具有较好的适用性。此外,GLIM标准、SGA、RFH-NPT分别与患者的临床结局相关。

Objective To investigate whether Royal Free Hospital Nutritional Prioritizing Tool(RFH-NPT)is more suitable than Nutritional Risk Screening 2002(NRS-2002)in nutritional risk screening for patients with liver cirrhosis,as well as the applicability of subjective global assessment(SGA)in the nutritional assessment of patients with liver cirrhosis.Methods A total of 113 patients with liver cirrhosis who were hospitalized in Renmin Hospital of Wuhan University from August 2020 to June 2021 were enrolled.RFH-NPT and NRS-2002 were used for nutritional risk screening,and SGA was used for nutritional assessment.The results of these tools were compared with the Global Leadership Initiative on Malnutrition(GLIM)criteria,and sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were calculated for the three tools.The receiver operating characteristic(ROC)curve was plotted and the area under the ROC curve(AUC)was calculated for each screening tool,and the association between nutritional status and short-term prognosis was analyzed.The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The Spearman correlation analysis was used to analyze the correlation of GLIM criteria with NRS2002,RFH-NPT and SGA.Results According to the GLIM criteria,69.9%of the patients were diagnosed with malnutrition,and RFH-NPT and NRS2002 screened out that 72.6%and 51.3%,respectively,of the patients had nutritional risk,while SGA assessment showed that 57.5%of the patients had malnutrition.Compared with NRS2002,RFH-NPT had a higher degree of correlation with the GLIM criteria(r=0.764,P<0.001),higher sensitivity(94.9%)and NPV(87.1%),and a better predictive value(AUC=0.872,95%confidence interval[CI]:0.786-0.957).Under the GLIM criteria,SGA had good specificity(88.2%)in the diagnosis of malnutrition in patients with liver cirrhosis,with fair sensitivity(77.2%),good correlation(r=0.607,P<0.001),and good predictive value(AUC=0.827,95%CI:0.744-0.911).Based on the GLIM criteria,SGA assessment,and RFH-NPT assessment,the patients with nutritional risk or malnutrition tended to have a longer length of hospital stay(Z=-3.301,-2.812,and-3.813,all P<0.05)and a higher rehospitalization rate(χ^(2)=3.957,6.922,and 6.766,all P<0.05).Based on the GLIM criteria and NRS2002 assessment,the patients with nutritional risk or malnutrition had a significant increase in mortality rate within 3 months(χ^(2)=4.511 and 0.776,both P<0.05).Conclusion Under the GLIM criteria,RFH-NPT is more suitable than NRS2002 for nutritional risk screening of patients with liver cirrhosis,and SGA also has good applicability in nutritional assessment of patients with liver cirrhosis.In addition,GLIM criteria,SGA,and RFH-NPT are associated with the clinical outcome of patients.