Abstract：
OBJECTIVE: 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.
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：全球领导营养不良倡议（GLIM）标准基于至少一种表型和一种病因学标准建立营养不良的诊断。本研究旨在评估GLIM标准在住院癌症患者中的并发和预测有效性。
方法：这是一项观察性回顾性研究，包括885名癌症患者,年龄>18岁，在2019年至2020年期间入住内科肿瘤科。根据营养风险筛查2002评分，所有有营养不良风险的患者均通过主观整体评估（SGA）和14种不同的GLIM标准组合进行评估。SGA被认为是评估GLIM组合的同时有效性的黄金标准。对于具有炎症标志物数据的患者子样本(n=198)，血清白蛋白和C-反应蛋白作为病原学标准纳入组合.使用手术并发症的发生作为临床结果来测试不同组合的预测有效性。计算敏感性和特异性值以评估并发有效性，使用单变量和多变量逻辑回归模型来检验预测有效性.适当的并发有效性和预测有效性分别确定为敏感性和特异性值>80％和比值比值≥2.0。
结果：患者的中位年龄为61.0y（四分位距=51.0-70.0）。头颈癌是主要诊断，375例患者有营养风险。根据SGA,173（26.1％）患者营养不良（SGAB类或C类），营养不良的患病率为3.9％至30.0％，根据GLIM组合。测试的组合都没有达到足够的并发有效性；然而，根据四种组合，营养不良的存在独立预测了手术并发症。
结论：GLIM在手术癌症患者中的预测有效性令人满意。
方法：这是一项观察性回顾性研究，包括885名癌症患者,年龄>18岁，在2019年至2020年期间入住内科肿瘤科。根据营养风险筛查2002评分，所有有营养不良风险的患者均通过主观整体评估（SGA）和14种不同的GLIM标准组合进行评估。SGA被认为是评估GLIM组合的同时有效性的黄金标准。对于具有炎症标志物数据的患者子样本(n=198)，血清白蛋白和C-反应蛋白作为病原学标准纳入组合.使用手术并发症的发生作为临床结果来测试不同组合的预测有效性。计算敏感性和特异性值以评估并发有效性，使用单变量和多变量逻辑回归模型来检验预测有效性.适当的并发有效性和预测有效性分别确定为敏感性和特异性值>80％和比值比值≥2.0。
结果：患者的中位年龄为61.0y（四分位距=51.0-70.0）。头颈癌是主要诊断，375例患者有营养风险。根据SGA,173（26.1％）患者营养不良（SGAB类或C类），营养不良的患病率为3.9％至30.0％，根据GLIM组合。测试的组合都没有达到足够的并发有效性；然而，根据四种组合，营养不良的存在独立预测了手术并发症。
结论：GLIM在手术癌症患者中的预测有效性令人满意。
