AND-ASPEN 和 ESPEN 共识以及 GLIM 标准在 AECOPD 患者营养不良识别中的应用：一项比较同期和预测效度的纵向研究。

AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity.

机构信息

Registered dietitian, Master student at Nutrition Science Postgraduation Program from Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.

Nutrition student at Federal University of Health Sciences from Porto Alegre, Porto Alegre, RS, Brazil.

出版信息

Eur J Clin Nutr. 2022 May;76(5):685-692. doi: 10.1038/s41430-021-01025-x. Epub 2021 Oct 26.

DOI:10.1038/s41430-021-01025-x

PMID:34702965

Abstract

BACKGROUND/OBJECTIVES: Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients.

SUBJECTS/METHODS: Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated.

RESULTS

In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes.

CONCLUSIONS

The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.

摘要

背景/目的：慢性阻塞性肺疾病（COPD）患者中营养不良很常见，通常通过体重指数（BMI）进行评估，但这可能导致误诊。主观全面评估（SGA）是住院患者诊断的参考方法。在过去十年中，出现了一些新的工具，包括美国肠外与肠内营养学会-临床营养学会（AND-ASPEN）、欧洲临床营养与代谢学会（ESPEN）和全球营养不良领导倡议（GLIM）。因此，本研究旨在评估这些工具在急性加重期 COPD（AECOPD）患者中的同时性和预测性有效性。

受试者/方法：前瞻性队列研究，纳入住院的 AECOPD 患者。营养不良通过 SGA（参考方法）、AND-ASPEN、ESPEN 和 GLIM 共识进行诊断。住院时间（LOS）和死亡率是评估的结局。

结果

在 241 名患者（46.5%为男性；68.3±10.2 岁）中，SGA 发现营养不良发生率为 50.0%，AND-ASPEN 为 54.4%，ESPEN 为 20.2%，GLIM 为 47.8%。AND-ASPEN 与 SGA 具有最佳的准确性（AUC=0.837；95%CI 0.783-0.841）和一致性（kappa=0.674），并且是 LOS 延长的独立预测因素（OR=1.73；95%CI 1.01-3.37）。ESPEN 共识与 SGA 不一致，但与 LOS 延长相关（OR=2.57；95%CI，1.27-5.20）。GLIM 与 SGA 具有良好的一致性（kappa=0.533）和准确性（AUC=0.768；95%CI 0.701-0.835），但与结局无关。