McFarlane M, Hammond C, Roper T, Mukarati J, Ford R, Burrell J, Gordon V, Burch N
Department of Gastroenterology, UHCW, Clifford Bridge Road, Coventry, UK.
Department of Gastroenterology, UHCW, Clifford Bridge Road, Coventry, UK.
Clin Nutr ESPEN. 2018 Feb;23:156-161. doi: 10.1016/j.clnesp.2017.10.009. Epub 2017 Nov 2.
Undernutrition in cirrhotic patients is often poorly recognised until late-stages. The current UK screening tool, the Malnutrition Universal Screening Tool, can miss undernutrition in patients with ascites/fluid retention. A 6-question Liver Disease Undernutrition Screening Tool (LDUST) has been developed in America.
We sought to compare LDUST with MUST in the detection of undernutrition in 50 inpatients and 50 outpatients with liver cirrhosis in a secondary care setting. This was then validated by a dietitian assessment.
Similar patient demographics and liver disease aetiologies were found in the two cohorts. Mean Child-Pugh scores were higher for inpatients, 8.3 (SD 1.9) vs 5.9 (SD 1.2). LDUST detected undernutrition in 45/50 inpatients (90%) and 34/50 outpatients (68%). MUST scores ≥2 were present in 19/50 (38%) inpatients and 9/50 (18%) outpatients. In those with a MUST score <2, LDUST detected undernutrition in 26/31 (84%) inpatients and 27/41 (66%) outpatients. 26 inpatients had undernutrition using LDUST but had a MUST score <2, 20 (76%) of these were deemed to be undernourished by dietetics assessment. LDUST was mostly completed independently or with minimal assistance (80% inpatients, 100% outpatients), with mean completion times of 4 and 3 min for in- and outpatients respectively.
LDUST is a quick and easy screening tool, which appears better able than MUST to detect undernutrition in cirrhotic patients, including undernutrition missed by MUST. Importantly the tool was validated against dietitian assessments. The high rates of undernutrition among cirrhotic inpatients suggest that screening this cohort is unnecessary, and instead all should undergo dietitian review, with LDUST utilised in an outpatient setting.
肝硬化患者的营养不良往往在晚期才被发现。目前英国的筛查工具——营养不良通用筛查工具（Malnutrition Universal Screening Tool）可能会遗漏腹水/液体潴留患者的营养不良情况。美国已开发出一种包含6个问题的肝病营养不良筛查工具（Liver Disease Undernutrition Screening Tool，LDUST）。
我们试图在二级医疗环境中，比较LDUST与MUST在50例肝硬化住院患者和50例肝硬化门诊患者中检测营养不良的效果。然后由营养师评估进行验证。
两个队列的患者人口统计学特征和肝病病因相似。住院患者的平均Child-Pugh评分较高，分别为8.3（标准差1.9）和5.9（标准差1.2）。LDUST在45/50例住院患者（90%）和34/50例门诊患者（68%）中检测出营养不良。MUST评分≥2的住院患者有19/50例（38%），门诊患者有9/50例（18%）。在MUST评分<2的患者中，LDUST在26/31例（84%）住院患者和27/41例（66%）门诊患者中检测出营养不良。26例住院患者使用LDUST检测出营养不良，但MUST评分<2，其中20例（76%）经营养师评估被认为营养不良。LDUST大多由患者独立完成或只需极少帮助（住院患者80%，门诊患者100%），住院患者和门诊患者的平均完成时间分别为4分钟和3分钟。
LDUST是一种快速简便的筛查工具，在检测肝硬化患者的营养不良方面似乎比MUST更有效，包括MUST遗漏的营养不良情况。重要的是，该工具已通过营养师评估进行了验证。肝硬化住院患者中营养不良发生率较高，这表明对该队列进行筛查没有必要，相反，所有患者都应接受营养师的评估，在门诊环境中使用LDUST。
