Diagnostic Accuracy of the Malnutrition Universal Screening Tool and Mini Nutritional Assessment Short‐Form in Outpatients With Pulmonary Hypertension

Several disease related factors of pulmonary hypertension (PH) can negatively impact the nutritional status, leading to an increased risk of malnutrition. However, there are no studies on the best method for nutritional screening in PH patients. Therefore, the aim of this study was to determine the diagnostic accuracy of two screening tools: the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short-Form (MNA-SF). This cross-sectional single center study included PH outpatients. Cut-off values MUST ≥ 1 and MNA-SF ≤ 11 were used for state of (risk of) malnutrition. The diagnostic criteria of the Global Leadership Initiative on Malnutrition (GLIM) were used as reference for diagnosing malnutrition. Diagnostic accuracy was determined by sensitivity, specificity, predictive positive value, negative predictive value, Cohen's Kappa- value (K) and area under the curve. Out of the 103 PH patients (age 67 years (SD 11.5), 66% female), 27% were malnourished according to the GLIM criteria. Both MUST and MNA-SF had an insufficient sensitivity (60.7% [CI: 41%-97%] vs. 64.3% [CI: 44%-81%]). The MUST had a specificity of 100% [CI: 95%-100%], PPV 100% [CI:94%-100%] and NPV 87.2% [CI:79%-93%]. The specificity of the MNA-SF was 81.3% [CI:70%-89%], PPV 56.3% [CI: 39%-73%] and NPV 85.9% [CI: 77%-93%]. The MUST had a higher K-value 0.692 and AUC (0.804) compared to the K-value 0.437 and AUC (0.728) of the MNA-SF. This study indicated that both MUST and MNA-SF are inaccurate to detect (risk of) malnutrition in PH outpatients. Future studies are needed to strive for a more sensitive screening tool.