FILNUT-scale: Rationale and use in screening for malnutrition risk within the INFORNUT process

Objectives

To offer a rationale for assigning a minimum score for risk of malnutrition for total proteins lower than 5 g/dl and a scoring scale for our filter (FILNUT-scale); and to analyse results of the MUST screening test performed on positive scores in the FILNUT nutritional filter and assess usefulness of said test in this population.

Methods

We searched the laboratory database for laboratory test orders (dated between 2004 and 2007) for which total proteins and albumin or cholesterol levels were determined, and we identified those with results for the above three parameters plus lymphocyte count. A limit (less than 5 g/dl) was placed on the total protein level and the results for other parameters were not limited. Distribution curves for albumin and cholesterol were analysed. The same protocol was followed after establishing the CONUT score for each sample with the necessary parameters.

From September 2007 to January 2008, the MUST test was performed on all FILNUT positives and we analysed how the degrees of risk corresponded.

Results

In 95% of the cases in which total proteins are lower than 5 g/dl (n = 1,176), albumin values are between 0.98 and 2.94 g/dl, resulting in CONUT scores of 4 or 6 for albumin. Regarding total cholesterol, (n = 761) 89.1% of the samples are lower than 180 mg/dl, which accounts for one or two points in the score.

In 98.79% of the cases (n = 490) that presented all four parameters, CONUT score was ≥5, which could be classified as medium or high risk.

During the study period, 100% of the patients identified as medium or high risk by the FILNUTscale (n = 568) tested as at-risk by MUST: of these, 421 (74.1%) were at high risk and 147 (25.9%) were at medium risk.