P99 Including nutritional screening into nurse led stable cirrhosis clinic reviews: insights gained, and lessons learnt using the liver disease under nutrition screening tool (LDUST) questionnaire

<h3></h3> Under nutrition in liver cirrhosis is very common and contributes to poorer prognosis (Traub et al 2021). Almost all guidelines and quality standards recommend regular nutritional screening or assessment in all cirrhotic patients and referral to dietitians where identified. Anthropometric measures such as hand grip strength, mid upper arm circumference and CT assessment of abdominal skeletal muscle are independent predictors of major complications and mortality. However, these methods and the screening tools which use them can be time consuming and difficult to interpret for non dietitian team members. LDUST is a validated screening tool involving six questions and does not require any anthropometric measures or detailed diet history interpretation. Data was collected for a 5-week period to ascertain how long completing the LDUST screening tool and mid upper arm circumference (MUAC) would take; also to gain insight into the proportion of compensated cirrhosis patients that would be identified as in need of nutritional support. Patients were asked to complete the LDUST questionnaire during their routine stable cirrhosis nurse led appointment. Patients that were not able to read or had sight difficulties were supported to complete the questions. Mid upper arm circumference was also taken just before the patient had bloods taken using a paper tape measure. It was not always possible to capture nutritional assessment data from every patient seen due to time constraints or if there were more pressing clinical issues discussed during the appointment. After 5–6 weeks we had screened 38 patients. Of which 16 had been identified as in need of nutritional evaluation. This accounts for 42% of ‘stable’ cirrhosis patients seen. Undertaking these extra interventions prompted discussions with patients and their supporters about the importance of nutrition and allowed time and space to discuss this and signpost to more information. It was possible to discuss the major role good nutrition plays in recompensation and is key to avoiding sarcopenia. All patients were compliant, and some were interested to understand the rationale behind obtaining baseline data to identify need and to act as a baseline to work against if they were to be admitted with a decompensated event. This highlights an unmet need in stable cirrhosis patients for early Dietician support. Based on the number of patients identified as at risk of under nutrition, to meet the need for our stable cirrhotic cohort of ~650 patients we would need an additional 0.3 WTE dietitians. <h3>Reference</h3> Traub J, Reiss L, Aliwa B, Stadlbauer V. Malnutrition in patients with liver cirrhosis<i>. Nutrients.</i> Feb 2021;<b>13</b>(2):540.