Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Clin Nutr. 2022 Mar;41(3):599-609. doi: 10.1016/j.clnu.2022.01.010. Epub 2022 Jan 13.
BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) is a new framework to evaluate nutritional status. It has been validated mostly by retrospective studies, which often failed to follow the framework as recommended due to their retrospective nature. This study aims to validate GLIM with a large prospective study and investigate its role in predicting short-term surgical outcomes.
Patients who underwent abdominal surgery for digestive cancer in our center were prospectively included between January 2020 and December 2020. Data collected included demographic information, clinical and pathological information, lab results, and computed tomography scans. Muscle strength, physical performances, quality of life and cancer symptom burden were evaluated upon admission. Multiple tools for nutritional risk screening were used. Nutritional status was evaluated with Subjective Global Assessment (SGA) and GLIM. Postoperative outcomes collected included return of gastrointestinal function, postoperative length of stay, complications, 30-day readmission and 30-day mortality.
A total of 1115 patients were evaluated with GLIM criteria. Inter-rater reliability was good [k = 0.76, 95% confidence interval (CI): 0.72-0.80]. The accuracy of GLIM diagnosis compared to the semi-gold standard SGA varied with the screening method used. GLIM with MNA-SF screening [area under the curve (AUC): 0.78] and GLIM without screening (AUC: 0.77) were the two most accurate protocols, and there was no significant difference between the two from a clinical perspective. GLIM can predict preoperative nutritional status, functional status, symptom burden and quality of life. It can also predict complications after surgery [odds ratio (OR) = 2.31, 95% CI: 1.67-3.21], especially infection related complications (OR = 2.19, 95% CI: 1.38-3.49) and wound healing related complications (OR = 2.54, 95% CI: 1.38-4.71).
GLIM malnutrition criteria showed good inner-rater reliability and moderate agreement with SGA. GLIM can be used to predict preoperative nutritional status, functional status, cancer related symptoms, and quality of life. It can also predict postoperative outcomes especially complications that are related to infection and wound healing. In surgical candidates, the screening process could potentially be skipped so that GLIM assessment can be faster, more accessible, and more sensitive.
全球营养不良领导倡议（GLIM）是一种评估营养状况的新框架。它主要通过回顾性研究进行了验证，由于回顾性研究的性质，这些研究往往未能按照建议的框架进行。本研究旨在通过一项大型前瞻性研究验证 GLIM，并探讨其在预测短期手术结果中的作用。
2020 年 1 月至 12 月，我们中心对因消化道癌症行腹部手术的患者进行了前瞻性纳入。收集的数据包括人口统计学信息、临床和病理信息、实验室结果和计算机断层扫描。入院时评估肌肉力量、身体表现、生活质量和癌症症状负担。使用多种营养风险筛查工具。使用主观全面评估（SGA）和 GLIM 评估营养状况。收集的术后结果包括胃肠道功能恢复、术后住院时间、并发症、30 天再入院和 30 天死亡率。
共有 1115 例患者根据 GLIM 标准进行了评估。组内信度良好[K=0.76，95%置信区间（CI）：0.72-0.80]。与半金标准 SGA 相比，GLIM 诊断的准确性因筛查方法而异。GLIM 联合 MNA-SF 筛查[曲线下面积（AUC）：0.78]和 GLIM 不筛查（AUC：0.77）是两种最准确的方案，从临床角度来看，两者之间没有显著差异。GLIM 可预测术前营养状况、功能状态、症状负担和生活质量。它还可以预测手术后的并发症[比值比（OR）=2.31，95%CI：1.67-3.21]，特别是感染相关并发症（OR=2.19，95%CI：1.38-3.49）和伤口愈合相关并发症（OR=2.54，95%CI：1.38-4.71）。
GLIM 营养不良标准显示出良好的内部信度和与 SGA 的中度一致性。GLIM 可用于预测术前营养状况、功能状态、癌症相关症状和生活质量。它还可以预测术后结果，特别是与感染和伤口愈合相关的并发症。在手术候选者中，筛选过程可能会被跳过，以便 GLIM 评估更快、更易获得且更敏感。
