Benchmarking Nutritional Screening Tools: An Assessment Against GlobalLeadership Initiative Criteria Among Patients Having Liver Cirrhosis

Introduction: Malnutrition, a prevalent complication of cirrhosis, requires prompt detection and intervention to reduce hospital stays, healthcare costs, enhance quality of life, and lower death rates. This study aimed to determine the frequency of malnutrition amongst patients with liver cirrhosis and to compare the diagnostic accuracy among various nutritional assessment tools for the detection of malnutrition. Methods: A cross-sectional study was conducted in confirmed patients of liver cirrhosis aged 18 and older, regardless of gender. Malnutrition was determined through GLIM (Global Leadership Initiative on Malnutrition) criteria. Various malnutrition assessment tools such as Hand Grip Strength (HGS), Royal Free Hospital- Global Assessment (RFH-GA), Liver Disease Undernutrition Screening Tool (LDUST), Nutrition Risk Screening (NRS-2002), Mini Nutrition Assessment (MNA) and Royal Free Hospital- Nutrition Prioritizing Tool (RFH-NPT), were put to use in order to determine nutritional status and compared for diagnostic accuracy. Results: From a total of 208 patients with liver cirrhosis, 139 (66.82%) had malnutrition. HGS and RFH-NPT evidently displayed the highest correlation (r = 0.513, 0.513) with GLIM criteria. HGS showed the highest accuracy in identifying malnutrition, with an area under the curve (AUC) of 0.78. The AUCs for RFH-NPT and RFH-GA were 0.77 and 0.76, respectively. When compared to the combined HGS-RFH-NPT based on the ROC curve, RFH-SGA (AUC = 0.98) and NRS-2002 (AUC = 0.98) showed the highest accuracy. RFH-GA and NRS-2002 displayed the highest correlation (r = 0.943, 0.943) with HGS*RFH-NPT. Discussion: The present research aims to evaluate the effectiveness of various screening techniques for identifying malnutrition in individuals with liver cirrhosis and to determine the prevalence of malnutrition. This study uses the Global Leadership Initiative on Malnutrition (GLIMS) criteria as a reference method for the determination of malnutrition, as validated by earlier studies. Various nutritional screening tools, such as (HGS, RFH-SGA, RFH-NPT, LDUST, NRS2002, and MNA) are assessed and compared with malnutrition based on GLIM in this study, which have shown statistical significance. HGS and RFH-NPT have shown a strong correlation with the malnutrition assessed by GLIM in this study. Earlier studies have also shown the strongest correlations between RFH-NPT and HGS and malnutrition, similar to this study. Some earlier studies have shown the highest agreement with RFH-NPT and NRS-2002 using GLIM criteria, which is slightly different from this study. Conclusion: Malnutrition is quite prevalent in patients with cirrhosis of the liver. Among various user-friendly, bedside, and non-invasive nutritional assessment tools, HGS has demonstrated the highest accuracy in detecting malnutrition, followed by RFH-NPT and RFH-GA.