Liu Qing, He Yumei, Yang Fang, Guo Gaoyue, Yang Wanting, Wu Liping, Sun Chao
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.
Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China.
Sci Prog. 2025 Jan-Mar;108(1):368504251320157. doi: 10.1177/00368504251320157.
Global Leadership Initiative on Malnutrition (GLIM) criteria have gradually accounted for the mainstay evaluating nutritional status. We sought to establish GLIM-dictated nomograms with other prognostic factors influencing long-term mortality and externally validate their predictive performance in decompensated cirrhosis.
The derivation cohort comprised 301 patients presenting with cirrhosis-associated acute insults, while the validation cohort encompassed 101 subjects from another tertiary hospital. Two nomograms were constructed to predict the 1-year all-cause mortality by integrating the GLIM criteria. The study population was stratified into low-, moderate- and high-risk mortality groups according to aforesaid proposed models.
Adjusting Child-Turcotte-Pugh classification (Nomo#1) or Model for End-stage Liver Disease-Sodium score (Nomo#2) separately, the GLIM criteria were independently associated with 1-year mortality in the multivariate Cox regression analysis (Nomo#1 hazard ratio (HR) = 3.139, < 0.001; Nomo#2 HR = 3.456, < 0.001). The C-index and time AUC for Nomo#1 and Nomo#2 performed significantly better than those of the GLIM criteria or conventional scoring systems alone. The survival rate of the low-risk group was significantly higher than those of the moderate- or high-risk groups (Nomo#1: 95% 65.8% 33.3%, < 0.001; Nomo#2: 94.3% 64.5% 25%, < 0.001). Furthermore, our proposed models exhibited moderate prediction accuracy and may identify malnourished patients with poor survival conditions in the external validation cohort.
GLIM criteria-defined malnutrition negatively impacted long-term mortality in the context of decompensated cirrhosis. Our established nomograms may predict survival status with sufficient discriminatory ability, alongside good consistency and clinical benefits, supporting their effectiveness in daily practice.
全球营养不良领导倡议（GLIM）标准已逐渐成为评估营养状况的主要依据。我们试图建立结合其他影响长期死亡率的预后因素的GLIM指导列线图，并在失代偿期肝硬化患者中对其预测性能进行外部验证。
推导队列包括301例出现肝硬化相关急性损伤的患者，验证队列包括来自另一家三级医院的101例患者。通过整合GLIM标准构建了两个列线图来预测1年全因死亡率。根据上述模型，将研究人群分为低、中、高风险死亡组。
在多变量Cox回归分析中，单独调整Child-Turcotte-Pugh分级（列线图#1）或终末期肝病-钠评分模型（列线图#2）后，GLIM标准与1年死亡率独立相关（列线图#1风险比（HR）=3.139，P<0.001；列线图#2 HR=3.456，P<0.001）。列线图#1和列线图#2的C指数和时间AUC显著优于单独的GLIM标准或传统评分系统。低风险组的生存率显著高于中、高风险组（列线图#1：95%对65.8%对33.
