Abstract：
OBJECTIVE: The clinical impact of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with kidney dysfunction remains poorly understood. This study investigated the usefulness of GLIM criteria for malnutrition in predicting mortality in patients with kidney dysfunction and different clinical renal states, including no kidney disease (NKD), acute kidney injury (AKI), and chronic kidney disease (CKD).
METHODS: This single-center retrospective cohort study included 6,712 patients aged ≥18 admitted between 2018 and 2019. The relationship between the estimated glomerular filtration rate (eGFR) groups, nutritional status based on the GLIM criteria, and the incidence of all-cause mortality was evaluated using a multivariate Cox proportional hazards model. Malnutrition was defined as at least one phenotype (weight loss, low body mass index, or reduced muscle mass) and one etiological criterion (reduced intake/assimilation or disease burden/inflammation).
RESULTS: Multivariate Cox proportional hazards model showed that eGFR ≤29 (vs. eGFR: 60-89, adjusted hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.52-2.22), 30-59 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.20-1.64), and ≥90 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.14-1.71), moderate and severe malnutrition (vs. without malnutrition, adjusted HR = 1.38 [1.18-1.62] and 2.18 [1.86-2.54], respectively) were independently associated with the incidence of death. The all-cause mortality rate was higher in patients with malnutrition or eGFR ≤29 (adjusted HR, 3.31; 95% CI: 2.51-4.35) than in patients without malnutrition or eGFR 60-89. Furthermore, moderate and severe malnutrition (vs. no malnutrition) was independently associated with death in patients with NKD, AKI, and CKD.
CONCLUSIONS: Malnutrition based on the GLIM criteria was associated with increased all-cause mortality in inpatients, and malnutrition combined with kidney dysfunction was associated with a higher risk of mortality. Furthermore, patients with NKD, AKI, and CKD showed an association between malnutrition based on GLIM criteria and mortality.
METHODS: This single-center retrospective cohort study included 6,712 patients aged ≥18 admitted between 2018 and 2019. The relationship between the estimated glomerular filtration rate (eGFR) groups, nutritional status based on the GLIM criteria, and the incidence of all-cause mortality was evaluated using a multivariate Cox proportional hazards model. Malnutrition was defined as at least one phenotype (weight loss, low body mass index, or reduced muscle mass) and one etiological criterion (reduced intake/assimilation or disease burden/inflammation).
RESULTS: Multivariate Cox proportional hazards model showed that eGFR ≤29 (vs. eGFR: 60-89, adjusted hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.52-2.22), 30-59 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.20-1.64), and ≥90 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.14-1.71), moderate and severe malnutrition (vs. without malnutrition, adjusted HR = 1.38 [1.18-1.62] and 2.18 [1.86-2.54], respectively) were independently associated with the incidence of death. The all-cause mortality rate was higher in patients with malnutrition or eGFR ≤29 (adjusted HR, 3.31; 95% CI: 2.51-4.35) than in patients without malnutrition or eGFR 60-89. Furthermore, moderate and severe malnutrition (vs. no malnutrition) was independently associated with death in patients with NKD, AKI, and CKD.
CONCLUSIONS: Malnutrition based on the GLIM criteria was associated with increased all-cause mortality in inpatients, and malnutrition combined with kidney dysfunction was associated with a higher risk of mortality. Furthermore, patients with NKD, AKI, and CKD showed an association between malnutrition based on GLIM criteria and mortality.
摘要：
目的：基于全球领导力营养不良倡议（GLIM）标准的营养不良对肾功能不全患者的临床影响尚不清楚。这项研究调查了GLIM标准对预测肾功能不全和不同临床肾脏状态患者死亡率的有用性。包括无肾脏疾病（NKD），急性肾损伤(AKI),慢性肾病（CKD）。
方法：这项单中心回顾性队列研究包括2018年至2019年期间收治的6,712名年龄≥18岁的患者。估计肾小球滤过率(eGFR)组间的关系，基于GLIM标准的营养状况，和全因死亡率的发生率使用多变量Cox比例风险(CPH)模型进行评估.营养不良被定义为至少一种表型(体重减轻，低体重指数（BMI），或减少肌肉质量）和一个病因标准（减少摄入量/同化或疾病负担/炎症）。
结果：多变量CPH模型显示eGFR≤29(vs.eGFR：60-89，调整后的HR=1.84，95%CI：1.52-2.22），30-59（vs.eGFR：60-89，调整后的HR=1.40，95%CI：1.20-1.64），和≥90(vs.eGFR：60-89，调整后的HR=1.40，95%CI：1.14-1.71），中度和重度营养不良(vs.没有营养不良，调整后的HR=1.38[1.18-1.62]和2.18[1.86-2.54]，分别)与死亡发生率独立相关。营养不良或eGFR≤29的患者的全因死亡率较高(调整后的HR，3.31；95%CI：2.51-4.35）高于无营养不良或eGFR60-89的患者。此外，中度和重度营养不良(vs.无营养不良）与NKD患者的死亡独立相关，AKI,CKD。
结论：基于GLIM标准的营养不良与住院患者全因死亡率增加相关，营养不良合并肾功能障碍与较高的死亡风险相关.此外，NKD患者,AKI,CKD显示基于GLIM标准的营养不良与死亡率之间存在关联.
方法：这项单中心回顾性队列研究包括2018年至2019年期间收治的6,712名年龄≥18岁的患者。估计肾小球滤过率(eGFR)组间的关系，基于GLIM标准的营养状况，和全因死亡率的发生率使用多变量Cox比例风险(CPH)模型进行评估.营养不良被定义为至少一种表型(体重减轻，低体重指数（BMI），或减少肌肉质量）和一个病因标准（减少摄入量/同化或疾病负担/炎症）。
结果：多变量CPH模型显示eGFR≤29(vs.eGFR：60-89，调整后的HR=1.84，95%CI：1.52-2.22），30-59（vs.eGFR：60-89，调整后的HR=1.40，95%CI：1.20-1.64），和≥90(vs.eGFR：60-89，调整后的HR=1.40，95%CI：1.14-1.71），中度和重度营养不良(vs.没有营养不良，调整后的HR=1.38[1.18-1.62]和2.18[1.86-2.54]，分别)与死亡发生率独立相关。营养不良或eGFR≤29的患者的全因死亡率较高(调整后的HR，3.31；95%CI：2.51-4.35）高于无营养不良或eGFR60-89的患者。此外，中度和重度营养不良(vs.无营养不良）与NKD患者的死亡独立相关，AKI,CKD。
结论：基于GLIM标准的营养不良与住院患者全因死亡率增加相关，营养不良合并肾功能障碍与较高的死亡风险相关.此外，NKD患者,AKI,CKD显示基于GLIM标准的营养不良与死亡率之间存在关联.
