不同的 GLIM 标准组合用于等待肝移植的患者：营养不良诊断的表现不佳，但可能是一种有用的预后工具。
Different combinations of the GLIM criteria for patients awaiting a liver transplant: Poor performance for malnutrition diagnosis but a potentially useful prognostic tool.
机构信息
Food Science Post-Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Nutrition and Health Post-Graduate Program, Universidade Federal de Lavras, Lavras, Minas Gerais, Brazil.
出版信息
Clin Nutr. 2022 Jan;41(1):97-104. doi: 10.1016/j.clnu.2021.11.008. Epub 2021 Nov 14.
BACKGROUND & AIMS: Studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with liver cirrhosis are limited. This study aimed to assess the impact of malnutrition according to the GLIM criteria on the outcomes of patients awaiting a liver transplant (LTx) and compare these criteria with Subjective Global Assessment (SGA).
METHODS
This retrospective observational study included adult patients awaiting LTx. Patient clinical data, nutritional status according to various tools including SGA, and resting energy expenditure were assessed. The distinct phenotypic and etiologic criteria provided 36 different GLIM combinations. The GLIM criteria and SGA were compared using the kappa coefficient. The variables associated with mortality before and after the LTx and with a longer length of stay (LOS) after LTx (≥18 days) were assessed by Cox regression and logistic regression analyses, respectively.
RESULTS
A total of 152 patients were included [median age 52.0 (interquartile range: 46.5-59.5) years; 66.4% men; 63.2% malnourished according to SGA]. The prevalence of malnutrition according to the GLIM criteria ranged from 0.7% to 30.9%. The majority of the GLIM combinations exhibited poor agreement with SGA. Independent predictors of mortality before and after LTx were presence of ascites or edema (p = 0.011; HR:2.58; CI95%:1.24-5.36), GLIM 32 (PA-phase angle + MELD) (p = 0.026; HR:2.08; CI95%:1.09-3.97), GLIM 33 (PA + MELD-Na≥12) (p = 0.018; HR:2.17; CI95%:1.14-4.13), and GLIM 34 (PA + Child-Pugh) (p = 0.043; HR:1.96; CI95%:1.02-3.77). Malnutrition according to GLIM 28 (handgrip strength + Child-Pugh) was independently associated with a longer LOS (p = 0.029; OR:7.21; CI95%:1.22-42.50).
CONCLUSION
The majority of GLIM combinations had poor agreement with SGA, and 4 of the 36 GLIM combinations were independently associated with adverse outcomes.
背景与目的
使用全球营养不良领导倡议 (GLIM) 标准评估肝硬化患者的研究有限。本研究旨在评估根据 GLIM 标准评估的营养不良对等待肝移植 (LTx) 患者结局的影响，并将这些标准与主观全面评估 (SGA) 进行比较。
方法
本回顾性观察性研究纳入了等待 LTx 的成年患者。评估了患者的临床数据、根据 SGA 等各种工具评估的营养状况和静息能量消耗。独特的表型和病因标准提供了 36 种不同的 GLIM 组合。使用 Kappa 系数比较 GLIM 标准和 SGA。使用 Cox 回归和逻辑回归分析分别评估 LTx 前后与 LTx 后（≥18 天）较长住院时间（LOS）相关的变量。
结果
共纳入 152 例患者[中位年龄 52.0（四分位间距：46.5-59.5）岁；66.4%为男性；63.2%根据 SGA 评估为营养不良]。根据 GLIM 标准评估的营养不良发生率为 0.7%至 30.9%。大多数 GLIM 组合与 SGA 一致性较差。LTx 前后死亡率的独立预测因素为腹水或水肿（p=0.011；HR：2.58；95%CI：1.24-5.36）、GLIM 32（PA 相位角+MELD）（p=0.026；HR：2.08；95%CI：1.09-3.97）、GLIM 33（PA+MELD-Na≥12）（p=0.018；HR：2.17；95%CI：1.14-4.13）和 GLIM 34（PA+Child-Pugh）（p=0.043；HR：1.96；95%CI：1.02-3.77）。根据 GLIM 28（握力+Child-Pugh）评估的营养不良与较长的 LOS 独立相关（p=0.029；OR：7.21；95%CI：1.22-42.50）。
结论
大多数 GLIM 组合与 SGA 一致性较差，36 种 GLIM 组合中有 4 种与不良结局独立相关。
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