Rapid Nutritional Screening and Short-Term Prognosis in Advanced Schistosomiasis: A Prospective Cohort Study.

PURPOSE: To identify an appropriate rapid nutritional screening tool for bedside use, and to determine whether early nutritional risk provide clinically meaningful prognostic information in advanced schistosomiasis.

METHODS

This prospective single-center cohort enrolled 436 patients with advanced schistosomiasis. Anthropometric indicators and four nutritional screening and assessment tools (NRS-2002, RFH-NPT, LDUST, and SGA) were applied. Agreement between tools was evaluated using Kappa statistics. Short-term prognosis was defined as adverse outcomes within 4 months. Multivariable and penalized logistic regression models identified prognostic nutritional indicators. Model performance was assessed using receiver operating characteristic curves, calibration, decision curve analysis, and net reclassification improvement. Clinical nomograms were developed.

RESULTS

The mean age was 63.19 ± 11.19 years and 54.6% were male. Using SGA as reference, LDUST showed the highest sensitivity (100%) and demonstrated favorable screening performance. SGA identified malnutrition in 14.2% of patients, while LDUST classified 50.0% as at nutritional risk. Triceps skinfold thickness (TSF), LDUST-defined risk, and SGA-defined malnutrition were relatively informative nutritional predictors. Models incorporating these measures demonstrated higher prognostic discrimination (AUC = 0.786, 95% CI 0.709–0.862) compared with clinical variables alone (AUC = 0.739, 95% CI 0.655–0.823). Higher TSF was associated with a lower risk of poor outcomes (OR = 0.945, 95% CI 0.895–0.998). Nomograms indicated TSF contributed the greatest prognostic weight among nutritional variables.

CONCLUSION

LDUST offers a feasible and sensitive tool for rapid bedside nutritional screening in advanced schistosomiasis. Nutrition-based assessments may provide modest additional prognostic information beyond clinical variables, supporting early risk stratification and targeted nutritional management, particularly in resource-limited settings where disease burden is high.