探索使用GLIM标准诊断癌症住院患者的营养不良情况。

Exploring the use of the GLIM criteria to diagnose malnutrition in cancer inpatients.

作者信息

Ozorio Gislaine Aparecida, Ribeiro Lia Mara Kauchi, Santos Bárbara Chaves, Bruzaca Wânnia Ferreira de Sousa, Rocha Gabriela Del Gallo Vieira da, Marchi Luani Maria da Fonseca, Santos Fernando Magri, Alves de Almeida Maria Manuela Ferreira, Kulcsar Marco Aurélio Vamondes, Junior Ulysses Ribeiro, Correia Maria Isabel Toulson Davisson, Waitzberg Dan Linetzky

机构信息

Nutrition and Dietetics Service, Cancer Institute of the State of São Paulo, São Paulo, Brazil.

出版信息

Nutrition. 2023 Dec;116:112195. doi: 10.1016/j.nut.2023.112195. Epub 2023 Aug 16.

DOI:10.1016/j.nut.2023.112195

PMID:37678014

Abstract

OBJECTIVES

The Global Leadership Initiative on Malnutrition (GLIM) criteria establish a diagnosis of malnutrition based on the presence of at least one phenotypic and one etiologic criterion. This study aimed to assess the concurrent and predictive validity of the GLIM criteria in hospitalized cancer patients.

METHODS

This is an observational retrospective study, including 885 cancer patients, ages >18 y, admitted to a medical oncology inpatient unit between 2019 and 2020. All patients at risk for malnutrition according to the Nutritional Risk Screening 2002 score were assessed by the subjective global assessment (SGA) and 14 different combinations of the GLIM criteria. The SGA was considered the gold standard for assessing the concurrent validity of the GLIM combinations. For a subsample of patients with data available on inflammatory markers (n = 198), the serum albumin and C-reactive protein were included in the combinations as etiologic criteria. The predictive validity of the different combinations was tested using the occurrence of surgical complications as the clinical outcome. The sensitivity and specificity values were calculated to assess the concurrent validity, univariate and multivariate logistic regression models were used to test predictive validity. Adequate concurrent and predictive validity were determined as sensitivity and specificity values >80% and odds ratio values ≥2.0, respectively.

RESULTS

The median age of the patients was 61.0 y (interquartile range = 51.0-70.0). Head and neck cancer was the prevailing diagnosis and 375 patients were at nutritional risk. According to the SGA, 173 (26.1%) patients were malnourished (SGA categories B or C) and the prevalence of malnutrition ranged from 3.9% to 30.0%, according to the GLIM combinations. None of the tested combinations reached adequate concurrent validity; however, the presence of malnutrition according to four combinations independently predicted surgical complications.

CONCLUSIONS

The predictive validity of the GLIM was satisfactory in surgical cancer patients.

摘要

目的

全球营养不良领导倡议（GLIM）标准基于至少一项表型标准和一项病因学标准来诊断营养不良。本研究旨在评估GLIM标准在住院癌症患者中的同时效度和预测效度。

方法

这是一项观察性回顾性研究，纳入了2019年至2020年间入住肿瘤内科住院病房、年龄大于18岁的885例癌症患者。根据2002年营养风险筛查评分，所有有营养不良风险的患者均通过主观全面评定法（SGA）以及GLIM标准的14种不同组合进行评估。SGA被视为评估GLIM组合同时效度的金标准。对于有炎症标志物数据的患者亚组（n = 198），血清白蛋白和C反应蛋白被纳入组合作为病因学标准。以手术并发症的发生作为临床结局来检验不同组合的预测效度。计算敏感度和特异度值以评估同时效度，使用单因素和多因素逻辑回归模型检验预测效度。充分的同时效度和预测效度分别定义为敏感度和特异度值大于80%以及优势比≥2.0。

结果

患者的中位年龄为61.0岁（四分位间距 = 51.0 - 70.0）。头颈部癌症是主要诊断，375例患者存在营养风险。根据SGA，173例（26.1%）患者营养不良（SGA分类为B或C），根据GLIM组合，营养不良的患病率在3.9%至30.0%之间。所测试的组合均未达到充分的同时效度；然而，根据四种组合判断存在营养不良可独立预测手术并发症。