Abstract：
Malnutrition significantly hampers wound healing processes. This study aimed to compare the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) and Subjective Global Assessment (SGA) in diagnosing malnutrition and predicting wound healing in patients with diabetic foot ulcers (DFU). GLIM criteria were evaluated for sensitivity (SE), specificity (SP), positive predictive value, negative predictive value and kappa (κ) against SGA as the reference. Modified Poisson regression model and the DeLong test investigated the association between malnutrition and non-healing ulcers over 6 months. This retrospective cohort study included 398 patients with DFU, with a mean age of 66·3 ± 11·9 years. According to SGA and GLIM criteria, malnutrition rates were 50·8 % and 42·7 %, respectively. GLIM criteria showed a SE of 67·3 % (95 % CI 60·4 %, 73·7 %) and SP of 82·7 % (95 % CI 76·6 %, 87·7 %) in identifying malnutrition, with a positive predictive value of 80·0 % and a negative predictive value of 71·1 % (κ = 0·50) compared with SGA. Multivariate analysis demonstrated that malnutrition, as assessed by SGA, was an independent risk factor for non-healing (relative risk (RR) 1·84, 95 % CI 1·45, 2·34), whereas GLIM criteria were associated with poorer ulcer healing in patients with estimated glomerular filtration rate ≥ 60 ml/min/1·73m2 (RR: 1·46, 95 % CI 1·10, 1·94). SGA demonstrated a superior area under the receiver\'s operating characteristic curve for predicting non-healing compared with GLIM criteria (0·70 (0·65-0·75) v. 0·63 (0·58-0·65), P < 0·01). These findings suggest that both nutritional assessment tools effectively identify patients with DFU at increased risk, with SGA showing superior performance in predicting non-healing ulcers.
摘要：
营养不良显著阻碍伤口愈合过程。这项研究旨在比较全球营养不良领导力倡议（GLIM）和主观全球评估（SGA）在诊断营养不良和预测糖尿病足溃疡（DFU）患者伤口愈合方面的有效性。评估GLIM标准的灵敏度(SE)，特异性（SP），阳性预测值(PPV)，负PV(NPV)，和Kappa(κ)对照SGA作为参考。改良的Poisson回归模型和DeLong检验研究了6个月内营养不良与溃疡不愈合之间的关系。这项回顾性队列研究包括398例DFU患者，平均年龄66.3±11.9岁。根据SGA和GLIM标准，营养不良率分别为50.8%和42.7%,分别。GLIM标准显示SE为67.3%(95%CI：60.4%，73.7%）和SP为82.7%（95%CI：76.6%，87.7%)在识别营养不良方面，与SGA相比，PPV为80.0%，NPV为71.1%(κ=0.50)。多变量分析表明，营养不良，根据SGA的评估，是不愈合的独立危险因素(相对风险[RR]1.84，95%CI：1.45，2.34)，而在肾小球滤过率估计≥60mL/min/1.73m2的患者中,GLIM标准与溃疡愈合较差相关(RR:1.46,95%CI:1.10,1.94).与GLIM标准相比，SGA在预测非愈合方面表现出优异的AUROC[0.70（0.65-0.75）与0.63（0.58-0.65），P<0.01]。这些发现表明，两种营养评估工具都有效地识别出DFU风险增加的患者。SGA在预测非愈合性溃疡方面表现优异。
