Malnutrition has become one of the adverse complications in patients with cirrhosis, and early nutritional screening and early identification of patients with cirrhosis can effectively improve clinical outcomes, however, the types of nutritional screening tools for patients with cirrhosis are varied and not yet standardized, and further research is needed.

To evaluate the applicability of 4 nutritional screening tools for patients with cirrhosis.

CNKI, VIP, Wanfang Data, PubMed, Embase, Cochrane Library and Web of Science were searched for diagnostic studies related to nutritional screening tool screens for malnutrition in cirrhotic patients. The search time was limited to December 2023. Two researchers individually read and filtered the literatures, extracted data, and assessed the bias risk of the incorporated researches. RevMan 5.4.1, Meta-DiSc, and StataMP 17.0 were used to perform network meta-analysis. The sensitivity, specificity, positive predictive value and negative predictive value of different nutritional screening tools were ranked by the surface under the cumulative ranking curve (SUCRA) .

5 Chinese and 5 English literatures were incorporated, totaling 10, including 1 299 patients; and four nutritional screening tools were included: the Nutritional Risk Screening 2002 (NRS2002), the Royal Free Hospital-Nutritional Prioritization Tool (RFH-NPT), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Assessment (SGA). The findings of meta-analysis revealed that the combined sensitivity of the four nutritional screening tools was 0.65 (95%CI=0.56-0.73), 0.93 (95%CI=0.89-0.96), 0.77 (95%CI=0.72-0.82), respectively. The combination specificity was 0.87 (95%CI=0.83-0.91), 0.72 (95%CI=0.64-0.79), 0.81 (95%CI=0.68-0.90), and MUST only be studied separately, without the combination sensitivity and combination specificity. The results of network meta-analysis showed the sensitivity and negative predictive value of SGA were lower than that of RFH-NPT (OR=0.03, 95%CI=0-0.55; OR=0.08, 95%CI=0.01-0.81, P<0.05) ; and the sensitivity and negative predictive value of RFH-NPT were higher than that of NRS2002 (OR=44.33, 95%CI=3.94-498.52; OR=17.68, 95%CI=2.13-147.05, P<0.05). The results of the combined subject work characterization curve (SROC) showed that the area under the SROC curve (AUC) for screening for malnutrition in cirrhotic patients was 0.86 for NRS2002, 0.90 for RFH-NPT, and 0.85 for SGA. The SUCRA values of the tools ranked in terms of combined sensitivity from highest to lowest were RFH-NPT (SUCRA=99.5%) >MUST (SUCRA=43.0%) >SGA (SUCRA=39.0%) >NRS2002 (SUCRA=18.5%) ; the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: MUST (SUCRA=91.4%) >NRS2002 (SUCRA=49.1%) >SGA (SUCRA=39.8%) >RFH-NPT (SUCRA=19.7%) ; the SUCRA values of these tools ranked in terms of positive predictive value from highest to lowest were MUST (SUCRA=95.2%) >RFH-NPT (SUCRA=37.4%) >NRS2002 (SUCRA=36.1%) >SGA (SUCRA=31.3%) ; the SUCRA values of these tools ranked in terms of negative predictive value from highest to lowest were RFH-NPT (SUCRA=99.1%) >MUST (SUCRA=44.9%) >SGA (SUCRA=39.4%) >NRS2002 (SUCRA=16.7%) .

The current evidence shows that RFH-NPT and MUST are suitable, but this conclusion still needs to be further confirmed by large samples and multiple high-quality studies.

营养不良已成为肝硬化患者不良并发症之一，尽早对肝硬化患者进行营养筛查与早期识别可以有效改善临床结局，但目前针对肝硬化患者的营养筛查工具种类多样，尚未统一，有待进一步研究。

系统评价4种营养筛查工具对肝硬化患者营养筛查的适用性。

计算机检索中国知网、万方数据知识服务平台、维普网、PubMed、Embase、Cochrane Library、Web of Science数据库中有关营养筛查工具筛查肝硬化患者营养不良的诊断性研究，检索时间为建库至2023年12月。由2名研究者独立阅读并筛选文献、提取数据资料及评价纳入研究的偏倚风险。应用RevMan 5.4.1、Meta-DiSc、StataMP 17.0软件进行网状Meta分析。通过累积排序概率曲线下面积（SUCRA）对不同营养筛查工具的灵敏度、特异度、阳性预测值、阴性预测值进行排序。

共纳入10篇文献，其中5篇中文文献，5篇英文文献；包含1 299例患者；纳入营养风险筛查2002（NRS2002）、皇家自由医院-营养优先排序工具（RFH-NPT）、营养不良通用筛查工具（MUST）、主观全面评定法（SGA）4种营养筛查工具。Meta分析结果显示，NRS2002、RFH-NPT、SGA 3种营养筛查工具的合并灵敏度分别为0.65（95%CI=0.56~0.73）、0.93（95%CI=0.89~0.96）、0.77（95%CI=0.72~0.82）；合并特异度分别为0.87（95%CI=0.83~0.91）、0.72（95%CI=0.64~0.79）、0.81（95%CI=0.68~0.90），MUST只有单独研究，不存在合并灵敏度与合并特异度。网状Meta分析结果显示，SGA的灵敏度、阴性预测值低于RFH-NPT（OR=0.03，95%CI=0~0.55；OR=0.08，95%CI=0.01~0.81，P<0.05）；RFH-NPT的灵敏度、阴性预测值高于NRS2002（OR=44.33，95%CI=3.94~498.52；OR=17.68，95%CI=2.13~147.05，P<0.05）。综合受试者工作特征曲线（SROC）结果显示，NRS2002筛查肝硬化患者营养不良的SROC曲线下面积（AUC）为0.86，RFH-NPT的AUC为0.90，SGA的AUC为0.85。4种营养筛查工具灵敏度的SUCRA排序结果从高到低依次显示：RFH-NPT（SUCRA=99.5%）>MUST（SUCRA=43.0%）>SGA（SUCRA=39.0%）>NRS2002（SUCRA=18.5%）；特异度的SUCRA排序结果从高到低显示：MUST（SUCRA=91.4%）>NRS2002（SUCRA=49.1%）>SGA（SUCRA=39.8%）>RFH-NPT（SUCRA=19.7%）；阳性预测值的SUCRA排序结果从高到低显示：MUST（SUCRA=95.2%）>RFH-NPT（SUCRA=37.4%）>NRS2002（SUCRA=36.1%）>SGA（SUCRA=31.3%）；阴性预测值的SUCRA排序结果从高到低显示：RFH-NPT（SUCRA=99.1%）>MUST（SUCRA=44.9%）>SGA（SUCRA=39.4%）>NRS2002（SUCRA=16.7%）。

当前证据表明RFH-NPT和MUST筛查肝硬化营养不良的适用性较好，但该结论仍需大样本、更严谨及多中心研究进一步证实。