Abstract：
OBJECTIVE: Malnutrition has adverse postoperative outcomes, especially in emergency surgery. Among the numerous tools for nutritional assessment, this study aims to investigate malnutrition diagnosed by Global Leadership Initiative on Malnutrition criteria and the Global Leadership Initiative on Malnutrition predictive value for outcomes after emergency abdominal surgery.
METHODS: This was a prospective observational study. Among the 468 patients undergoing emergency abdominal surgery admitted to a department of emergency surgery from June 2020 to December 2021, 53 patients were not eligible for enrollment, and 19 patients had missing data. Thus, the final number of participants was 396. Muscle mass was evaluated by skeletal muscle index at the third lumbar vertebra on computed tomography scans, and the lower quartile was defined as the threshold of muscle mass reduction. The associations of Global Leadership Initiative on Malnutrition, Global Leadership Initiative on Malnutrition (muscle mass reduction excluded), and skeletal muscle index with in-hospital mortality, postoperative complications, and postoperative stay were evaluated using χ2. In addition, confounding factors were screened, regression models were established, and the Global Leadership Initiative on Malnutrition predictive value was analyzed for clinical outcome. Ethical approval was obtained from the appropriate department.
RESULTS: Malnutrition was observed in 19.9% of the total 396 patients based on the Global Leadership Initiative on Malnutrition and in 12.4% on the Global Leadership Initiative on Malnutrition (muscle mass reduction excluded). Sarcopenia by skeletal muscle index was found in 24.7% of patients. Univariate analysis indicated that in-hospital mortality, postoperative complications, infective complication rate, and postoperative hospital stay were significantly higher in malnourished and sarcopenic patients. Multivariate analysis found that malnutrition diagnosed by the Global Leadership Initiative on Malnutrition was predictive for complications, infective complications, and postoperative stay (total postoperative complications: odds ratio = 3.620; 95% CI, 1.635-8.015; P = 0.002; infective complications: odds ratio = 3.127; 95% CI, 1.194-8.192; P = 0.020; and postoperative stay: regression coefficient = 2.622; P = 0.022). The Global Leadership Initiative on Malnutrition (muscle mass reduction excluded) identified postoperative complications and postoperative stay (total postoperative complications: odds ratio = 3.364; 95% CI, 1.247-9.075; P = 0.017 and postoperative stay: regression coefficient = 3.547; P = 0.009). Sarcopenia by skeletal muscle index was a risk factor for postoperative complications (odds ratio = 3.366; 95% CI, 1.587-7.140; P = 0.002).
CONCLUSIONS: The Global Leadership Initiative on Malnutrition and Global Leadership Initiative on Malnutritison (muscle mass reduction excluded) had predictive value for adverse clinical outcomes due to malnutrition in patients undergoing emergency abdominal surgery.
METHODS: This was a prospective observational study. Among the 468 patients undergoing emergency abdominal surgery admitted to a department of emergency surgery from June 2020 to December 2021, 53 patients were not eligible for enrollment, and 19 patients had missing data. Thus, the final number of participants was 396. Muscle mass was evaluated by skeletal muscle index at the third lumbar vertebra on computed tomography scans, and the lower quartile was defined as the threshold of muscle mass reduction. The associations of Global Leadership Initiative on Malnutrition, Global Leadership Initiative on Malnutrition (muscle mass reduction excluded), and skeletal muscle index with in-hospital mortality, postoperative complications, and postoperative stay were evaluated using χ2. In addition, confounding factors were screened, regression models were established, and the Global Leadership Initiative on Malnutrition predictive value was analyzed for clinical outcome. Ethical approval was obtained from the appropriate department.
RESULTS: Malnutrition was observed in 19.9% of the total 396 patients based on the Global Leadership Initiative on Malnutrition and in 12.4% on the Global Leadership Initiative on Malnutrition (muscle mass reduction excluded). Sarcopenia by skeletal muscle index was found in 24.7% of patients. Univariate analysis indicated that in-hospital mortality, postoperative complications, infective complication rate, and postoperative hospital stay were significantly higher in malnourished and sarcopenic patients. Multivariate analysis found that malnutrition diagnosed by the Global Leadership Initiative on Malnutrition was predictive for complications, infective complications, and postoperative stay (total postoperative complications: odds ratio = 3.620; 95% CI, 1.635-8.015; P = 0.002; infective complications: odds ratio = 3.127; 95% CI, 1.194-8.192; P = 0.020; and postoperative stay: regression coefficient = 2.622; P = 0.022). The Global Leadership Initiative on Malnutrition (muscle mass reduction excluded) identified postoperative complications and postoperative stay (total postoperative complications: odds ratio = 3.364; 95% CI, 1.247-9.075; P = 0.017 and postoperative stay: regression coefficient = 3.547; P = 0.009). Sarcopenia by skeletal muscle index was a risk factor for postoperative complications (odds ratio = 3.366; 95% CI, 1.587-7.140; P = 0.002).
CONCLUSIONS: The Global Leadership Initiative on Malnutrition and Global Leadership Initiative on Malnutritison (muscle mass reduction excluded) had predictive value for adverse clinical outcomes due to malnutrition in patients undergoing emergency abdominal surgery.
摘要：
目的：营养不良有不良的术后结局，尤其是在急诊手术中。在众多的营养评估工具中，本研究旨在调查全球领导力营养不良倡议标准和全球领导力营养不良倡议诊断的营养不良对紧急腹部手术后结局的预测价值.
方法：这是一项前瞻性观察性研究。在2020年6月至2021年12月急诊外科收治的468名接受急诊腹部手术的患者中，有53名患者不符合入学条件，19例患者的数据缺失。因此，最终参与者人数为396。在计算机断层扫描扫描中，通过第三腰椎的骨骼肌指数评估肌肉质量，下四分位数定义为肌肉质量减少的阈值。全球营养不良问题领导倡议协会，全球营养不良领导力倡议（不包括减少肌肉质量），和骨骼肌指数与住院死亡率，术后并发症,术后住院时间采用χ2评价。此外,筛选混杂因素，建立了回归模型，全球领导力倡议对营养不良预测价值进行了临床结局分析。从适当的部门获得了道德批准。
结果：根据全球营养不良领导力倡议，在396名患者中，有19.9%的患者出现营养不良，在全球营养不良领导力倡议中，有12.4%的患者出现营养不良（不包括肌肉质量减少）。在24.7％的患者中发现了骨骼肌指数的肌肉减少症。单因素分析表明，院内死亡率，术后并发症,感染性并发症发生率，营养不良和肌少症患者的术后住院时间显着增加。多因素分析发现，全球领导力营养不良倡议诊断的营养不良是并发症的预测因素，感染性并发症,术后总并发症:比值比=3.620;95%CI,1.635-8.015;P=0.002;感染性并发症:比值比=3.127;95%CI,1.194-8.192;P=0.020;术后停留时间:回归系数=2.622;P=0.022。营养不良全球领导力倡议（不包括肌肉量减少）确定了术后并发症和术后住院时间（术后总并发症：比值比=3.364；95％CI，1.247-9.075；P=0.017，术后住院时间：回归系数=3.547；P=0.009）。骨骼肌指数的肌肉减少是术后并发症的危险因素（比值比=3.366；95％CI，1.587-7.140；P=0.002）。
结论：关于营养不良的全球领导力倡议和关于营养不良的全球领导力倡议（不包括肌肉质量减少）对于接受紧急腹部手术的患者由于营养不良导致的不良临床结局具有预测价值。
方法：这是一项前瞻性观察性研究。在2020年6月至2021年12月急诊外科收治的468名接受急诊腹部手术的患者中，有53名患者不符合入学条件，19例患者的数据缺失。因此，最终参与者人数为396。在计算机断层扫描扫描中，通过第三腰椎的骨骼肌指数评估肌肉质量，下四分位数定义为肌肉质量减少的阈值。全球营养不良问题领导倡议协会，全球营养不良领导力倡议（不包括减少肌肉质量），和骨骼肌指数与住院死亡率，术后并发症,术后住院时间采用χ2评价。此外,筛选混杂因素，建立了回归模型，全球领导力倡议对营养不良预测价值进行了临床结局分析。从适当的部门获得了道德批准。
结果：根据全球营养不良领导力倡议，在396名患者中，有19.9%的患者出现营养不良，在全球营养不良领导力倡议中，有12.4%的患者出现营养不良（不包括肌肉质量减少）。在24.7％的患者中发现了骨骼肌指数的肌肉减少症。单因素分析表明，院内死亡率，术后并发症,感染性并发症发生率，营养不良和肌少症患者的术后住院时间显着增加。多因素分析发现，全球领导力营养不良倡议诊断的营养不良是并发症的预测因素，感染性并发症,术后总并发症:比值比=3.620;95%CI,1.635-8.015;P=0.002;感染性并发症:比值比=3.127;95%CI,1.194-8.192;P=0.020;术后停留时间:回归系数=2.622;P=0.022。营养不良全球领导力倡议（不包括肌肉量减少）确定了术后并发症和术后住院时间（术后总并发症：比值比=3.364；95％CI，1.247-9.075；P=0.017，术后住院时间：回归系数=3.547；P=0.009）。骨骼肌指数的肌肉减少是术后并发症的危险因素（比值比=3.366；95％CI，1.587-7.140；P=0.002）。
结论：关于营养不良的全球领导力倡议和关于营养不良的全球领导力倡议（不包括肌肉质量减少）对于接受紧急腹部手术的患者由于营养不良导致的不良临床结局具有预测价值。
