Wu Bei-Wen, Yin Tao, Cao Wei-Xin, Gu Zhi-Dong, Wang Xiao-Jin, Yan Min, Liu Bing-Ya
Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
World J Gastroenterol. 2009 Jul 28;15(28):3542-9. doi: 10.3748/wjg.15.3542.
To investigate the role of subjective global assessment (SGA) in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer.
A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.
Based on the results of SGA, 389 (51.8%), 332 (44.2%), and 30 (4.0%) patients were classified into well nourished group (SGA-A), mildly to moderately malnourished group (SGA-B), and severely malnourished group (SGA-C), respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness (TSF), mid-upper arm muscle circumference (MAMC), albumin (ALB), prealbumin (PA), and body mass index (BMI) was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index (BMI), TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were (P < 0.05). Chi2 tests showed a significant difference in SGA classification between patients receiving different types of treatment (surgery vs chemotherapy/radiotherapy). As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group (23.3%) and the lowest in the SGA-A group (16.8%).
SGA is a reliable assessment tool and helps to predict the hospital stay and medical expenditures of Chinese surgical gastrointestinal cancer patients.
探讨主观全面评定法（SGA）在中国胃肠道癌患者营养评估及预后预测中的作用。
选取2004年8月至2006年8月期间确诊的751例胃肠道癌患者纳入本研究。入院后72小时内，采用SGA、人体测量参数及实验室检查评估每位患者的营养状况。同时获取包括住院时间、并发症及住院医疗费用等结局变量。
根据SGA结果，分别有389例（51.8%）、332例（44.2%）和30例（4.0%）患者被分为营养良好组（SGA - A）、轻度至中度营养不良组（SGA - B）和重度营养不良组（SGA - C）。按SGA、三头肌皮褶厚度（TSF）、上臂中部肌肉周长（MAMC）、白蛋白（ALB）、前白蛋白（PA）及体重指数（BMI）分类的营养不良患病率分别为48.2%、39.4%、37.7%、31.3%、21.7%和9.6%。此外，方差分析显示不同SGA组患者的体重指数（BMI）、TSF、PA和ALB存在显著差异。患者营养不良越严重，BMI、TSF、PA和ALB水平越低（P < 0.05）。卡方检验显示接受不同治疗类型（手术与化疗/放疗）的患者在SGA分类上存在显著差异。随着SGA分类的营养状况恶化，患者住院时间延长且医疗费用显著增加。此外，多元回归分析表明SGA和血清ALB有助于预测手术患者的医疗费用和住院时间。并发症的发生率随SGA等级升高而增加，在SGA - C组最高（23.3%），在SGA - A组最低（16.8%）。
SGA是一种可靠的评估工具，有助于预测中国胃肠道癌手术患者的住院时间和医疗费用。
