Miwa Takao, Hanai Tatsunori, Nishimura Kayoko, Unome Shinji, Maeda Toshihide, Ogiso Yui, Imai Kenji, Suetsugu Atsushi, Takai Koji, Shimizu Masahito
Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.
Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
Hepatol Res. 2022 Nov;52(11):928-936. doi: 10.1111/hepr.13816. Epub 2022 Aug 17.
AIM: The Global Leadership Initiative on Malnutrition (GLIM) criteria, a newly developed global consensus around core diagnostic criteria for malnutrition, needs validation studies for use in daily clinical settings. This study aimed to determine whether the GLIM criteria could predict sarcopenia and mortality in patients with chronic liver disease (CLD). METHODS: We retrospectively reviewed 858 patients with CLD who were treated at our hospital between March 2013 and December 2019. Sarcopenia was diagnosed based on the criteria proposed by the Japan Society of Hepatology. Malnutrition was assessed using the GLIM criteria, subjective global assessment (SGA), and Royal Free Hospital-global assessment (RFH-GA) and their predictive ability for sarcopenia and mortality were assessed using the logistic regression analysis and the Cox proportional hazards regression model, respectively. RESULTS: Among the eligible 406 patients, 67% were men, the median age was 74 years, and 26% had sarcopenia. The prevalence of malnutrition according to the GLIM criteria, SGA, and RFH-GA was 21%, 35%, and 26%, respectively. Comparing malnourished with well-nourished patients, the odds ratio for complicating sarcopenia was 2.54 (95% confidence interval [CI], 1.44-4.49) for the GLIM criteria, 2.13 (95% CI, 1.09-4.15) for the SGA, and 2.78 (95% CI, 1.56-4.95) for the RFH-GA. During a median follow-up period of 2.0 years, 176 (43%) patients died. After adjusting for confounding factors, the GLIM criteria could independently predict mortality (hazard ratio, 1.95; 95% CI, 1.37-2.81). CONCLUSIONS: The GLIM criteria are useful in identifying sarcopenia and predicting mortality in patients with CLD.
目的:全球营养不良领导倡议(GLIM)标准是围绕营养不良核心诊断标准新形成的全球共识,需要在日常临床环境中进行验证研究。本研究旨在确定GLIM标准能否预测慢性肝病(CLD)患者的肌肉减少症和死亡率。 方法:我们回顾性分析了2013年3月至2019年12月在我院接受治疗的858例CLD患者。根据日本肝病学会提出的标准诊断肌肉减少症。使用GLIM标准、主观全面评定法(SGA)和皇家自由医院全面评定法(RFH-GA)评估营养不良情况,并分别使用逻辑回归分析和Cox比例风险回归模型评估它们对肌肉减少症和死亡率的预测能力。 结果:在符合条件的406例患者中,67%为男性,中位年龄为74岁,26%患有肌肉减少症。根据GLIM标准、SGA和RFH-GA评估的营养不良患病率分别为21%、35%和26%。将营养不良患者与营养良好的患者进行比较,GLIM标准下并发肌肉减少症的比值比为2.54(95%置信区间[CI],1.44 - 4.49),SGA为2.13(95% CI,1.09 - 4.15),RFH-GA为2.78(95% CI,1.56 - 4.95)。在中位随访期2.0年期间,176例(43%)患者死亡。在调整混杂因素后,GLIM标准能够独立预测死亡率(风险比,1.95;95% CI,1.37 - 2.81)。 结论:GLIM标准有助于识别CLD患者的肌肉减少症并预测其死亡率。
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