Xu Li-Bin, Shi Ming-Ming, Huang Ze-Xin, Zhang Wei-Teng, Zhang Hui-Hui, Shen Xian, Chen Xiao-Dong
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
JPEN J Parenter Enteral Nutr. 2022 Feb;46(2):385-394. doi: 10.1002/jpen.2127. Epub 2021 May 27.
Our objective is to validate the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria in malnutrition diagnosis compared with Patient-Generated Subjective Global Assessment (PG-SGA) and assess the impact of malnutrition diagnosed using GLIM criteria on the clinical outcomes of patients with GC.
We retrospectively analyzed the data of 895 patients who underwent radical gastrectomy at the First Affiliated Hospital of Wenzhou Medical University. Nutrition assessment was performed on all patients according to the GLIM criteria and PG-SGA. The κ statistic was used to evaluate the agreement between two methods. Multivariate logistic regression and Cox regression based on single-factor analysis were used to predict postoperative complications and overall survival rates.
Based on the GLIM criteria, 38.3% of the patients were diagnosed as malnourished, including 21.7% Stage I (moderate malnutrition) and 16.6% Stage II (severe malnutrition). GLIM criteria had a moderate agreement with PG-SGA (κ = 0.548). Patients in the Stage II malnutrition group had a higher incidence of complications, a longer postoperative length of stay, and higher hospitalization costs. Logistic regression showed that Stage II malnutrition was an independent risk predictor of postoperative complications (odds ratio, 3.28; 95% confidence interval [CI], 2.18-4.94). Furthermore, Cox regression analysis showed that both Stage I (hazard ratio [HR], 1.52; 95% CI, 1.11-2.07; P = .009) and Stage II (HR, 1.85; 95% CI, 1.34-2.53; P < .001) malnutrition were independent risk predictors of overall survival.
Diagnosis of malnutrition according to the GLIM criteria is useful in predicting the adverse postoperative clinical outcomes of patients with gastric cancer.
我们的目的是验证营养不良全球领导倡议（GLIM）标准在营养不良诊断方面相对于患者主观整体评定法（PG-SGA）的有效性，并评估使用GLIM标准诊断的营养不良对胃癌患者临床结局的影响。
我们回顾性分析了温州医科大学附属第一医院895例行根治性胃切除术患者的数据。根据GLIM标准和PG-SGA对所有患者进行营养评估。采用κ统计量评估两种方法之间的一致性。基于单因素分析的多因素逻辑回归和Cox回归用于预测术后并发症和总生存率。
根据GLIM标准，38.3%的患者被诊断为营养不良，其中Ⅰ期（中度营养不良）占21.7%，Ⅱ期（重度营养不良）占16.6%。GLIM标准与PG-SGA具有中等一致性（κ = 0.548）。Ⅱ期营养不良组患者并发症发生率更高，术后住院时间更长，住院费用更高。逻辑回归显示，Ⅱ期营养不良是术后并发症的独立风险预测因素（比值比，3.28；95%置信区间[CI]，2.18 - 4.94）。此外，Cox回归分析显示，Ⅰ期（风险比[HR]，1.52；95% CI，1.11 - 2.07；P = 0.009）和Ⅱ期（HR，1.85；95% CI，1.34 - 2.53；P < 0.001）营养不良均是总生存的独立风险预测因素。
根据GLIM标准诊断营养不良有助于预测胃癌患者术后不良临床结局。
