Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
Clin Nutr. 2023 Oct;42(10):2036-2044. doi: 10.1016/j.clnu.2023.08.020. Epub 2023 Sep 1.
BACKGROUND & AIMS: Systemic inflammation is a key pathogenic criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Although cancer is commonly considered as a chronic inflammation-related disease, the inflammatory burden may vary depending on the type and stage of cancer. Therefore, a more precise definition of inflammation criteria could facilitate the identification of malnutrition in cancer.
This prospective multicenter study included 1683 cancer patients screened via NRS2002 for malnutrition risk. The inflammatory burden index (IBI), C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and albumin (ALB) level were used to assess the inflammatory burden. Kaplan-Meier and Cox regression analyses were used to determine the relationship between the GLIM criteria and overall survival. Harrell's concordance index (C-index) was used to compare the discriminative performance of the original, IBI-based, CRP-based, NLR-based, and ALB-based GLIM criteria for survival. Logistic regression models were used to assess the association between GLIM criteria and short-term outcomes, length of hospital stay, and hospitalization costs.
Compared to the original GLIM criteria, the IBI/CRP/NLR/ALB-based GLIM criteria better predicted the long-term outcomes of patients with cancer (chi-square: 1.316 vs. 78.321 vs. 74.740 vs. 88.719 vs. 100.921). The C-index revealed that the inflammation marker-based GLIM criteria showed significantly better prognostic accuracy than the original GLIM criteria. The ALB-based GLIM criteria exhibited the best prognostic accuracy. The inflammation marker-based GLIM criteria were independent predictive factors for the long-term prognosis of cancer. Patients with malnutrition had a 45% higher risk of adverse long-term prognoses than those without malnutrition. The inflammation marker-based GLIM criteria had good prognostic ability to predict outcomes at 3, 6, and 12 months. The stepwise effect of the grading of severity via the IBI-based GLIM criteria and CRP-based GLIM criteria was notable. The inflammation marker-based GLIM criteria are useful for predicting short-term outcomes, length of hospitalization, and hospitalization costs.
The inflammation marker-based GLIM criteria have a stronger predictive value than the original GLIM criteria in evaluating both the short- and long-term prognoses of cancer patients. It is recommended to use the inflammation marker-based GLIM criteria for nutritional evaluation of cancer patients.
全身性炎症是使用全球营养不良倡议 (GLIM) 标准诊断营养不良的关键病理标准。尽管癌症通常被认为是一种与慢性炎症相关的疾病，但炎症负担可能因癌症的类型和阶段而异。因此，更精确的炎症标准定义可以促进癌症患者营养不良的识别。
本前瞻性多中心研究纳入了 1683 例通过 NRS2002 筛查出有营养不良风险的癌症患者。使用炎症负担指数 (IBI)、C 反应蛋白 (CRP) 水平、中性粒细胞与淋巴细胞比值 (NLR) 和白蛋白 (ALB) 水平来评估炎症负担。采用 Kaplan-Meier 和 Cox 回归分析来确定 GLIM 标准与总生存期之间的关系。Harrell 一致性指数 (C 指数) 用于比较基于原始标准、IBI 标准、CRP 标准、NLR 标准和 ALB 标准的 GLIM 标准对生存的判别性能。Logistic 回归模型用于评估 GLIM 标准与短期结局、住院时间和住院费用之间的关系。
与原始 GLIM 标准相比，IBI/CRP/NLR/ALB 为基础的 GLIM 标准更好地预测了癌症患者的长期结局（卡方检验：1.316 比 78.321 比 74.740 比 88.719 比 100.921）。C 指数表明，基于炎症标志物的 GLIM 标准对癌症患者的预后具有更好的预测准确性。ALB 为基础的 GLIM 标准具有最佳的预后准确性。基于炎症标志物的 GLIM 标准是癌症患者长期预后的独立预测因素。营养不良患者发生不良长期预后的风险比无营养不良患者高 45%。基于炎症标志物的 GLIM 标准对 3、6 和 12 个月的结局有良好的预后预测能力。基于 IBI 标准和 CRP 标准的严重程度分级的逐步效应显著。基于炎症标志物的 GLIM 标准可用于预测短期结局、住院时间和住院费用。
基于炎症标志物的 GLIM 标准在评估癌症患者的短期和长期预后方面比原始 GLIM 标准具有更强的预测价值。建议使用基于炎症标志物的 GLIM 标准对癌症患者进行营养评估。
