Nutritional risk assessment using the Nutritional Prognostic Index predicts mortality in Advanced Chronic Liver Disease patients

Introduction

Early clinical prognosis and mortality reduction remains a challenge in Chronic Liver Disease (CLD). The full potential of the Nutritional Prognostic Index (NPI) for nutritional assessment and management in CLD patients remains unexplored.

Aim

To establish an NPI cutoff point for identification of nutritional risk in advanced CLD (ACLD) patients, and to assess the NPI's ability to predict ACLD-associated mortality.

Method

This ethically approved prospective cohort study investigated malnutrition risk using both the NPI and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in patients hospitalized for ACLD. NPI reference values were determined using Receiver Operating Characteristic curve. Associations between nutritional risk identified by RFH-NPT and by NPI were assessed using Fisher's exact test, and agreement between tools assessed using the Kappa index. Association between NPI-defined nutritional risk and 12-month mortality was examined using Pearson Chi-square test.

Results

The sample population consisted of 120 adults, 84 (70%) male and 57 (50.9%) of alcoholic aetiology, presenting Child-Pugh A, B or C at admission. The identified cutoff point for NPI was <41, identifying nutritional risk in 82.5% of patients. NPI presented a statistically significant association with RFH-NPT, with substantial agreement coefficient of 0.34. Association between NPI <41 cutoff and mortality were observed, with 82.1% of the sample below cutoff experiencing mortality within 12 months.

Conclusion

NPI is a valuable nutritional marker for identification of nutritional risk in ACLD. The NPI is a simple and effective assessment tool which can aid in CLD early diagnosis. Validation however remains necessary in other CLD populations of different aetiologies.