GLIM、主观全面评定法（SGA）、患者主观全面评定法（PG-SGA）和预后营养指数（PNI）在诊断肝胆胰手术患者营养不良中的比较。
Comparison of GLIM, SGA, PG-SGA, and PNI in diagnosing malnutrition among hepatobiliary-pancreatic surgery patients.
作者信息
Zhou Lingmei, Fu Jianying, Ding Zhen, Jin Kemei, Wu Runjingxing, Ye Ling Xiao
机构信息
Clincal Nutrition Department, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China.
Department of Hepatobiliary-Pancreatic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China.
出版信息
Front Nutr. 2023 Jan 24;10:1116243. doi: 10.3389/fnut.2023.1116243. eCollection 2023.
OBJECTIVE
To compare the diagnostic value of four tools-the Global Leadership Initiative on Malnutrition (GLIM) criteria, the subjective global assessment (SGA), patient-generated subjective global assessment (PG-SGA), and prognostic nutritional index (PNI) in malnutrition among hospitalized patients undergoing hepatobiliary-pancreatic surgery. Meanwhile, to observe the nutritional intervention of these patients.
METHODS
Present study was a cross-sectional study, including 506 hospitalized patients who underwent hepatobiliary-pancreatic surgery between December 2020 and February 2022 at Ningbo Medical Center Lihuili Hospital, China. The incidence rate of malnutrition was diagnosed using the four tools. The consistency of the four tools was analyzed by Cohen's kappa statistic. Data, including nutritional characteristics and nutritional interventions, were collected. The nutritional intervention was observed according to the principles of Five Steps Nutritional Treatment.
RESULTS
The prevalence was 36.75, 44.58, and 60.24%, as diagnosed by the GLIM, PG-SGA, and PNI, respectively, among 332 tumor patients. Among the 174 non-tumor patients, the prevalence was 9.77, 10.92, and 32.18% as diagnosed by the GLIM, SGA, and PNI. The diagnostic concordance of PG-SGA and GLIM was higher (Kappa = 0.814, <0.001) than SGA vs. GLIM (Kappa = 0.752, < 0.001) and PNI vs. GLIM (Kappa = 0.265, < 0.001). The univariate analysis revealed that older age, lower BMI and tumorous were significantly associated with nutritional risks and malnutrition. Among 170 patients with nutritional risk, most of patients (118/170, 69.41%) did not meet the nutritional support standard.
CONCLUSION
The incidence of nutritional risk and malnutrition is high among patients with hepatobiliary and pancreatic diseases, specifically those with tumors. The GLIM showed the lowest prevalence of malnutrition among the four tools. The PG-SGA and GLIM had a relative high level of agreement. There was a low proportion of nutritional support in patients. More prospective and well-designed cohort studies are needed to confirm the relevance of these criteria in clinical practice in the future.
目的
比较全球营养不良领导倡议（GLIM）标准、主观全面评定法（SGA）、患者主观全面评定法（PG-SGA）和预后营养指数（PNI）这四种工具对肝胆胰手术住院患者营养不良的诊断价值。同时，观察这些患者的营养干预情况。
方法
本研究为横断面研究，纳入了2020年12月至2022年2月在中国宁波市医疗中心李惠利医院接受肝胆胰手术的506例住院患者。使用这四种工具诊断营养不良的发生率。采用Cohen's kappa统计量分析这四种工具的一致性。收集包括营养特征和营养干预在内的数据。按照五步营养治疗原则观察营养干预情况。
结果
在332例肿瘤患者中，经GLIM、PG-SGA和PNI诊断的营养不良患病率分别为36.75%、44.58%和60.24%。在174例非肿瘤患者中，经GLIM、SGA和PNI诊断的营养不良患病率分别为9.77%、10.92%和32.18%。PG-SGA与GLIM的诊断一致性高于SGA与GLIM（Kappa = 0.814，<0.001）以及PNI与GLIM（Kappa = 0.265，<0.001）。单因素分析显示，年龄较大、BMI较低和患有肿瘤与营养风险和营养不良显著相关。在170例有营养风险的患者中，大多数患者（118/170，69.41%）未达到营养支持标准。
结论
肝胆胰疾病患者，尤其是肿瘤患者，营养风险和营养不良的发生率较高。GLIM在这四种工具中显示出最低的营养不良患病率。PG-SGA与GLIM具有较高的一致性。患者中营养支持的比例较低。未来需要更多前瞻性和设计良好的队列研究来证实这些标准在临床实践中的相关性。
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