GLIM 营养不良定义中的体重减轻和 BMI 标准与腹部切除术后的术后并发症相关 - 来自国家质量登记处的结果。
Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections - Results from a National Quality Registry.
机构信息
Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
出版信息
Clin Nutr. 2020 May;39(5):1593-1599. doi: 10.1016/j.clnu.2019.07.003. Epub 2019 Jul 20.
BACKGROUND & AIMS: Although malnutrition is thought to be common among patients with intraabdominal diseases and is recognized as a risk factor for postoperative complications, diagnostic criteria for malnutrition have not been consistent. Thus, the Global Leadership Initiative in Malnutrition (GLIM) has recently published new criteria for malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to weight loss and BMI criteria in GLIM's second step for the diagnosis and their association with severe postoperative complications in patients undergoing gastrointestinal resections.
METHOD
The current study includes adult patients who were prospectively included in the Norwegian Registry for Gastrointestinal Surgery in the period between 2015 and 2018. Exclusion criteria were acute surgery and lack of information regarding preoperative weight and/or postoperative complications. Severe surgical complications were classified according to the Revised Accordion Classification system and malnutrition with the GLIM criteria. Associations were assessed by logistic regression analyses, and the adjusted odds ratio included age (continuous), gender (male/female) and scores from the American Society of Anesthesiologists Physical Status Classification System and the Eastern Cooperative Oncology Group.
RESULTS
Out of 6110 patients, 2161 (35.4%) were classified as with malnutrition, 1206 (19.7%) with moderate and 955 (15.6%) with severe malnutrition. Malnourished patients were 1.29 (95% CI: 1.13-1.47) times more likely to develop severe surgical complications, and 2.15 (95% CI: 1.27-3.65) times more likely to die within 30 days, as compared to those who were not.
CONCLUSION
Preoperative malnutrition is common among patients having gastrointestinal resections and is associated with an increased risk of severe surgical complications.
背景与目的
尽管人们认为腹腔疾病患者普遍存在营养不良，且营养不良被认为是术后并发症的危险因素，但营养不良的诊断标准并不一致。因此，全球营养不良领导倡议（GLIM）最近发布了营养不良的新标准。本研究旨在根据 GLIM 第二步诊断中的体重减轻和 BMI 标准调查营养不良的患病率，以及其与接受胃肠切除术患者严重术后并发症的关系。
方法
本研究纳入了 2015 年至 2018 年期间前瞻性纳入挪威胃肠外科登记处的成年患者。排除标准为急性手术和缺乏术前体重和/或术后并发症信息。严重手术并发症根据修订后的 Accordion 分类系统和 GLIM 标准进行分类。通过逻辑回归分析评估相关性，调整后的比值比包括年龄（连续）、性别（男性/女性）以及美国麻醉医师协会身体状况分类系统和东部合作肿瘤学组的评分。
结果
在 6110 名患者中，2161 名（35.4%）被归类为营养不良，1206 名（19.7%）为中度营养不良，955 名（15.6%）为重度营养不良。与未发生严重手术并发症的患者相比，营养不良患者发生严重手术并发症的可能性高 1.29 倍（95%CI：1.13-1.47），30 天内死亡的可能性高 2.15 倍（95%CI：1.27-3.65）。
结论
接受胃肠切除术的患者术前营养不良较为常见，且与严重手术并发症风险增加相关。
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