GLIM诊断的营养不良与充血性心力衰竭住院成人18个月死亡率之间的关联：一项前瞻性队列研究。

Association between GLIM diagnosed malnutrition and 18-month mortality in hospitalized adults with congestive heart failure: A prospective cohort study.

作者信息

Duan Ruoshu, Chen Suxiu, Li Suxia, Ding Jie, Wang Lei, Li Yangli, Ren Jingjing, Jiang Sujing

机构信息

Department of General Practice, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.

Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, PR China.

出版信息

JPEN J Parenter Enteral Nutr. 2025 Jul;49(5):633-642. doi: 10.1002/jpen.2760. Epub 2025 Apr 13.

DOI:10.1002/jpen.2760

PMID:40221875

Abstract

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) criteria have been validated in various clinical settings since 2018, but prospective validation in patients with congestive heart failure (CHF) who are hospitalized remains limited. This study compares the prognostic performance of the GLIM criteria and Mini-Nutritional Assessment (MNA)-defined malnutrition for all-cause mortality in CHF patients and explores the strongest predictive indicator within the GLIM criteria.

METHODS

This single-center prospective cohort study included inpatients with CHF. Agreement between the GLIM criteria and MNA was assessed using Cohen κ coefficient. Survival data were analyzed using Kaplan-Meier curves and adjusted Cox regression analyses.

RESULTS

Among 498 CHF inpatients, 84 (16.9%) died during the 18-month follow-up. Malnutrition prevalence was 47.2% and 50.4% based on the GLIM criteria and MNA, respectively (κ = 0.68; P < 0.001). Malnutrition was independently associated with a higher risk of all-cause mortality (GLIM criteria: hazard ratio, 2.16 [95% confidence interval (CI), 1.13-4.13]; MNA: hazard ratio, 4.28 [95% CI, 1.98-9.22]). Low body mass index was the strongest predictor of all-cause mortality in multivariable analysis (hazard ratio, 5.14; 95% CI, 3.19-8.27).

CONCLUSION

The GLIM criteria showed strong consistency with MNA and effectively predicted all-cause mortality in CHF patients within 18 months.

摘要

背景

全球营养不良领导倡议（GLIM）标准自2018年以来已在各种临床环境中得到验证，但在住院的充血性心力衰竭（CHF）患者中的前瞻性验证仍然有限。本研究比较了GLIM标准和简易营养评估（MNA）定义的营养不良对CHF患者全因死亡率的预后表现，并探索GLIM标准中最强的预测指标。

方法

这项单中心前瞻性队列研究纳入了CHF住院患者。使用Cohen κ系数评估GLIM标准和MNA之间的一致性。生存数据采用Kaplan-Meier曲线和校正的Cox回归分析进行分析。

结果

在498例CHF住院患者中，84例（16.9%）在18个月的随访期间死亡。根据GLIM标准和MNA，营养不良患病率分别为47.2%和50.4%（κ = 0.68；P < 0.001）。营养不良与全因死亡风险较高独立相关（GLIM标准：风险比，2.16 [95%置信区间（CI），1.13 - 4.13]；MNA：风险比，4.28 [95% CI，1.98 - 9.22]）。在多变量分析中，低体重指数是全因死亡率的最强预测指标（风险比，5.14；95% CI，3.19 - 8.27）。