The patient generated subjective global assessment short form is a useful screening tool to detect risk for malnutrition in patients with cirrhosis.

BACKGROUND AND AIMS: Malnutrition is a modifiable risk factor for morbidity and mortality in cirrhosis. Nutrition risk screening is recommended in cirrhosis nutrition guidelines, but is not routinely completed in practice. The patient-generated subjective global assessment short form (PG-SGA SF) is a patient-completed screen that has potential to be a substitute for more time and resource intensive nutrition screens. The aim of this cross-sectional study was to compare the PG-SGA SF and three other patient-completed screens against the nutrition assessment reference method in cirrhosis, the Royal Free Hospital subjective global assessment (RFH-SGA). We also explored whether being classified "at-risk" on a nutritional screening tool was associated with clinical outcomes of unplanned hospitalization or death. METHODS: Patients completed four nutrition screening tools with or without support from a caregiver. The RFH-SGA was carried out by a blinded registered dietitian. The four screening tools were compared against the RFH-SGA to calculate sensitivity, specificity, and positive and negative predictive value. RESULTS: A total of 121 patients were included. The PG-SGA SF screened the highest number of patients positive for malnutrition risk (52%), was the most accurate, and had the highest sensitivity. Being at risk for malnutrition on the PG-SGA SF was associated with a higher risk of unplanned hospitalization (unadjusted sHR 2.78 (95% CI 1.3-5.9), p = 0.009). CONCLUSIONS: The PG-SGA SF identifies malnutrition risk at similar or superior rates to other patient-generated screening tools in patients with cirrhosis. Our findings support its potential as a patient completed solution for identifying malnutrition risk in cirrhosis.

Noninvasive assessment oesophageal varices: impact of the Baveno VI criteria.

PURPOSE OF REVIEW: In 2015, as a consequence of the high development in noninvasive tests, Baveno VI consensus recommended for the first time the use of a prediction rule (liver stiffness <20kPa and platelet count > 150000) to identify patients at low risk of having varices and that could circumvent endoscopy. These became known as the Baveno VI criteria. We review here the data validating Baveno VI criteria and we discuss the attempts of expanding these criteria. RECENT FINDINGS: We report 28 studies assessing the performance of Baveno VI criteria showing a pooled 99% negative predictive value for ruling out high-risk varices. Performance is not affected by the cause of cirrhosis. Different attempts at expanding these criteria show suboptimal performance. Nonelastography-based criteria require further validation. SUMMARY: Baveno VI criteria can be safely used to avoid endoscopy in a substantial proportion of patients with compensated cirrhosis. The progressive change in approach to the management of compensated cirrhosis, progressively focusing on treating portal hypertension with beta-blockers independently of the presence of varices, might render these criteria less relevant.