Nutrition Department, Hospital San Ángel Inn Universidad, Mexico City, Mexico.
Nutrition Department, Hospital San Ángel Inn Universidad, Mexico City, Mexico.
Clin Nutr ESPEN. 2020 Aug;38:67-73. doi: 10.1016/j.clnesp.2020.06.015. Epub 2020 Jul 7.
BACKGROUND & AIMS: Malnutrition is considered a risk factor for many complications and mortality among hospitalized patients. Until 2016 there was a wide variety of clinical definitions for malnutrition, until the GLIM criteria proposed a consensual definition. The main goal of this study is to assess the performance of the GLIM criteria at acute care admission to detect those patients with adverse clinical outcomes such as mortality and the need to be transferred to critical care areas (CCA).
This was a prospective observational study including every adult patient admitted to the regular ward of the Hospital San Ángel Inn Universidad. Every nutrition and demographic variable evaluated by the nutrition team at hospital admission was captured. The malnutrition definition according to the GLIM and separate criteria were tested for their performance to detect patients at high risk for adverse outcomes (mortality and the need to be transferred to CCA), using odd ratios (OR), their confidence interval of 95% (CI95%) and binary logistic regression accordingly.
A total of 1015 patients were included in the final analysis, with a prevalence of 18.9% of malnutrition (according to the GLIM definition) at hospital admission. Malnutrition was associated with mortality (OR of 59.69,CI95% 7.76-459.28) and unplanned transfer to CCA (OR of 9.453, CI95%4.35-20.56). However, despite being sensitive, the GLIM definition of malnutrition, displayed low positive predictive value, and was therefore associated with many false positives. There was a trend for higher risks for adverse outcomes with higher severity of malnutrition. Muscle wasting, chronic and acute inflammation were independent predictors for mortality and for unplanned transfer to CCA.
Malnutrition according to the GLIM criteria is strongly associated with mortality and transfer to CCA. Muscle wasting and inflammation (acute and chronic) were independently associated with these outcomes.
营养不良被认为是住院患者发生许多并发症和死亡的危险因素。直到 2016 年，才有多种临床营养不良定义，直到 GLIM 标准提出了一个共识定义。本研究的主要目的是评估 GLIM 标准在急性护理入院时的表现，以发现那些有不良临床结局（如死亡率和需要转入重症监护病房（CCA））的患者。
这是一项前瞻性观察性研究，包括每一位入住圣安格尔因诺大学综合医院普通病房的成年患者。入院时营养团队评估的每一个营养和人口统计学变量都被记录下来。根据 GLIM 和单独的标准，对营养不良的定义进行了测试，以发现有不良结局（死亡率和需要转入 CCA）高风险的患者，使用比值比（OR）、95%置信区间（CI95%）和相应的二项逻辑回归。
共有 1015 例患者纳入最终分析，入院时营养不良的患病率为 18.9%（根据 GLIM 定义）。营养不良与死亡率（OR 为 59.69，CI95%为 7.76-459.28）和非计划转入 CCA（OR 为 9.453，CI95%为 4.35-20.56）相关。然而，尽管 GLIM 营养不良定义具有较高的敏感性，但阳性预测值较低，因此与许多假阳性相关。营养不良的严重程度越高，不良结局的风险越高。肌肉减少症、慢性和急性炎症是死亡率和非计划性转入 CCA 的独立预测因素。
根据 GLIM 标准，营养不良与死亡率和转入 CCA 密切相关。肌肉减少症和炎症（急性和慢性）与这些结局独立相关。
