验证一种识别肝硬化非卧床患者营养不足的筛查工具
背景：美国慢性肝病的发生率逐渐增加。营养不良随着肝病进展普遍存在。但缺乏一种公认的方法来筛查这些患者的营养不良。开发6问题营养不足筛查工具供没有接受营养培训的人员识别肝硬化患者营养状况的下降。在肝硬化非卧床患者中完成三阶段验证研究，评估该筛查工具的表面效度、内容效度和临床有效性。
方法：在第I阶段，调查13位肝病专业人员确定表面效度。在第II阶段，调查12位专攻肝病的注册营养师来评估内容效度。在第III阶段，进行横断面调查研究，比较营养不足筛查工具与注册营养师（RD）进行的营养评估之间的一致性。
结果：22名诊断肝硬化的患者参与第三阶段调查。注册营养师评估发现82%的患者存在营养不足（95% CI：60%～95%）。κ统计表明该筛查工具与注册营养师评估之间一致性较好。该工具的敏感性和特异性分别为72%和75%，阳性预测率为93%。
结论：第I、II和III阶段的反馈结果表明该营养不足筛查工具简单，易于操作，其测定的结构内容与肝病营养不足具有最强的联系。该筛查工具还需进行小的调整和多中心调查研究，以证实其临床有效性和交叉效度。
Nutr Clin Pract. 2015;30(5):683-9.
Validation of a Screening Tool to Identify Undernutrition in Ambulatory Patients With Liver Cirrhosis.
Booi AN, Menendez J, Norton HJ, Anderson WE, Ellis AC.
Carolinas Healthcare System, Charlotte, North Carolina.
University of Alabama, Tuscaloosa, Alabama.
BACKGROUND: The prevalence of chronic liver disease is increasing in the United States. Malnutrition is common as liver disease progresses. However, an accepted method to screen these patients for malnutrition is lacking. The 6-question undernutrition screening tool was developed for professionals without nutrition training to identify a decline in the nutrition status of patients with liver cirrhosis. A 3-phase validation study was completed to assess face, content, and clinical validity of the screening tool in ambulatory patients with liver cirrhosis.
METHODS: In phase I, face validity was determined by surveying 13 liver disease professionals. In phase II, content validity was assessed by surveying 12 registered dietitians who specialize in liver disease. In phase III, a cross-sectional investigation was completed to compare the agreement between the undernutrition screening tool and nutrition assessment by a registered dietitian (RD).
RESULTS: Twenty-two patients with a diagnosis of liver cirrhosis participated in phase III of the investigation. The RD assessment identified undernutrition in 82% of patients (95% CI, 60%-95%). The κ statistic indicated a fair agreement between the screening tool and RD assessment. Sensitivity and specificity of the tool were 72% and 75%, respectively, and positive predictive value was 93%.
CONCLUSIONS: Feedback from phase I, II, and III indicate that the undernutrition screening tool is simple, is easy to use, and measures the constructs that have the strongest link with undernutrition in liver disease. Additional minor adjustments to the screening tool and a multicenter investigation are indicated to confirm clinical effectiveness and cross-validity of the tool.
KEYWORDS: end-stage liver disease; liver cirrhosis; liver diseases; malnutrition; nutrition assessment
PMID: 26024676
DOI: 10.1177/0884533615587537