Karanikki Eva, Frountzas Maximos, Lidoriki Irene, Kozadinos Alexandros, Mylonakis Adam, Tsikrikou Iliana, Kyriakidou Maria, Toutouza Orsalia, Koniaris Efthimios, Theodoropoulos George E, Theodorou Dimitrios, Schizas Dimitrios, Toutouzas Konstantinos G
Department of Clinical Nutrition, Hippocration General Hospital, 11527 Athens, Greece.
1st Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
J Clin Med. 2024 Dec 9;13(23):7479. doi: 10.3390/jcm13237479.
Malnutrition affects patients undergoing surgery for gastrointestinal cancers and contributes to poor postoperative outcomes, including increased complication rates, longer hospital stays, and higher mortality. Despite the availability of several malnutrition screening tools and prognostic scores, their effectiveness in predicting postoperative outcomes remains unclear. This study aimed to compare the predictive accuracy of Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score for postoperative outcomes in patients undergoing surgery for colorectal, hepato-pancreato-biliary and upper gastrointestinal cancers. A cross-sectional observational study from March 2022 to October 2023 was conducted in two university surgical departments, after registration on ClinicalTrials database (NCT05795374). Patient characteristics, preoperative nutritional status and postoperative outcomes were analyzed. In total, 480 patients were enrolled. CONUT and GNRI demonstrated high specificity (over 90% and 80%, respectively) for predicting overall complications, major complications, prolonged hospital stay, mortality, and advanced disease stage across all cancer types. Notably, CONUT showed a specificity over 97% and GNRI over 89.7% for colorectal and upper gastrointestinal cancer patients, respectively, despite their lower sensitivity. On the contrary, PG-SGA and GLIM presented better sensitivity (up to 50%), but slightly lower specificity (up to 86.4%). CONUT and GNRI are valuable for ruling out non-at-risk patients for adverse postoperative outcomes, while PG-SGA and GLIM provide better sensitivity. A step-up approach-initial screening with PG-SGA and GLIM, followed by detailed evaluation with CONUT or GNRI- should be validated in future studies across diverse clinical settings.
营养不良会影响接受胃肠道癌手术的患者，并导致术后不良后果，包括并发症发生率增加、住院时间延长和死亡率升高。尽管有几种营养不良筛查工具和预后评分，但它们在预测术后结果方面的有效性仍不明确。本研究旨在比较患者主观全面评定法（PG-SGA）、营养不良全球领导倡议（GLIM）、老年营养风险指数（GNRI）和控制营养状况（CONUT）评分对结直肠癌、肝胰胆管癌和上胃肠道癌手术患者术后结果的预测准确性。在两个大学外科科室进行了一项横断面观察性研究，时间为2022年3月至2023年10月，研究已在临床试验数据库（NCT05795374）注册。分析了患者特征、术前营养状况和术后结果。总共招募了480名患者。CONUT和GNRI在预测所有癌症类型的总体并发症、主要并发症、住院时间延长、死亡率和疾病晚期方面表现出高特异性（分别超过90%和80%）。值得注意的是，尽管CONUT和GNRI对结直肠癌和上胃肠道癌患者的敏感性较低，但它们的特异性分别超过97%和89.7%。相反，PG-SGA和GLIM表现出更好的敏感性（高达50%），但特异性略低（高达86.4%）。CONUT和GNRI对于排除术后不良后果的非风险患者很有价值，而PG-SGA和GLIM提供了更好的敏感性。一种逐步推进的方法——先用PG-SGA和GLIM进行初步筛查，然后用CONUT或GNRI进行详细评估——应在未来不同临床环境的研究中得到验证。
