SGA和GLIM评估肝衰竭患者营养状态一致性分析

doi:10.3969/j.issn.1672-5069.2025.02.017

Abstract

Abstract: Objective The aim of this study was to compare subjective global assessment (SGA) and global leaders malnutrition initiative (GLIM) standards in the assessment of malnutrition in patients with liver failure (LF). Methods A total of 110 patients with LF were encountered in Beijing You'an hospital between 2020 and 2023, including subacute liver failure (SALF) in 26 cases, acute-on-chronic liver failure (ACLF) in 43 cases and chronic liver failure (CLF) in 41 cases; Malnutrition was screened by nutritional risk screening 2002 (NRS2002), SGA and GLIM, and the consistency was compared by Kappa test. Results The nutritional risk incidence rate of all patients assessed by NRS2002 was 51.8%, by SGA was 60.9%, which was higher than 50.0% assessed by GLIM (P＜0.05); serum prealbumin (PA) level in malnutrition group was significantly lower than in normal nutrition group in patients with SALF (P<0.05); in patients with ACLF, the body mass index (BMI) in malnutrition group was significantly lower than in normal group, while total serum bilirubin (TSB) level was significantly higher than in normal group (P＜0.05). serum PA and prothrombin time activity (PTA) in malnutrition group evaluated by SGA were significantly lower than in normal group, and 28 d fatality rate in malnutrition group by GLIM was significantly higher than in normal (P<0.05); in patients with CLF, TSB level in malnutrition group was significantly higher than in normal group, while BMI, PA and PTA in malnutrition group by SGA were significantly lower than in normal group; the BMI, PA and blood hemoglobin (HGB) levels in malnutrition group by GLIM were significantly lower than in normal group (P<0.05); Kappa test showed that SGA and GLIM had a good consistency in the evaluation of malnutrition in patients with LF (Kappa = 0.615,P＜0.001). Conclusion The incidence rates of nutritional risk and malnutrition are high in patients with LF, and majority of patients with malnutrition con be identified by SGA than GLIM. The evaluation results in ACLF and CLF are consistent by SGA than GLIM, we recommend NRS2002 for nutritional risk assessment in patients with SALF, and those with malnutrition should be carefully supported.

Key words: Liver failure, Malnutrition, Subjective global assessment, Global leadership initiative on malnutrition, Diagnosis

Ban Lingwei, Yang Qinbing, Hua Xin. Subjective global assessment and global leaders malnutrition initiative standards in the assessment of malnutrition in patients with liver failure[J]. Journal of Practical Hepatology, 2025, 28(2): 226-229.

References

[1] 中华医学会感染病学分会肝衰竭与人工肝学组;中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版).实用肝脏病杂志,2019,22(2):164-171.
[2] 段钟平,杨云生.终末期肝病临床营养指南.实用肝脏病杂志,2019,22(5):624-635.
[3] Llibre-Nieto G, Lira A, Vergara M, et al. Micronutrient deficiencies in patients with decompensated liver cirrhosis.Nutrients,2021,13(4):1249.
[4] Leunts S, Vandecruys M, Van Craenenbroeck AH, et al. Sarcopenia in end-stage liver disease and after liver transplantation. Acta Gastroenterolo Belg, 2023,86(2):323-334.
[5] Chiriac S, Stanciu C, Cojocariu C, et al. Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure.World J Clin Cases,2021,9(3):552-564.
[6] 李璐,陈煜.肝衰竭的营养评估及营养干预研究进展.中华肝脏病杂志.2017,25(7):548-552.
[7] Buchard B, Boirie Y, Cassagnes L, et al. Assessment ofmalnutrition, sarcopenia and frailty in patients with cirrhosis: Which tools should we use in clinical Practice? Nutrients,2020, 12(1):186.
[8] Zhang X, Tang M, Zhang Q, et al. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients. Clin Nutr,2021,40(3):1224－1232.
[9] Ishida Y, Maeda K, Nonogiki T, et al. Impact of edema on length of calf circumference in older adults. Geriat Gerontol Int,2019, 19(10):993-998.
[10] Traub J, Bergheim I, Horvath A, et al. Validation of malnutrition screening tools in liver cirrhosis. Nutrients,2020,12(5):1306.
[11] Allard JP, Keller H, Gramlich L, et al. GLIM criteria has fair sensitivity and specificity for diagnosing malnutrition when using SGA as comparator. Clin Nutr, 2020,39(9):2771-2777.
[12] Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition : A consensus report from the global clinical nutrition community. Clin Nutr, 2019, 38(1):1-9.
[13] Schober P,Mascha EJ,Vetter TR.Statistics from A ( Agreement) to Z (Z score) : a guide to interpreting common measures of association, agreement, diagnostic accuracy,effect size, heterogeneity, and reliability in medical research. Anesth Analg, 2021,133 (6): 1633-1641.
[14] Yao J,Zhou X,Wang H, et al. Persistently increased resting energy expenditure predicts short-term mortality in patients with acute - on - chronic liver failure. Ann Nutr Metab,2018,73(1):2-9.
[15] 杨晓玲,张素梅.SGA,MNA和NRS2002评估失代偿期肝硬化患者营养状态应用价值分析.实用肝脏病杂志,2020,23(1):70-73.
[16] Rui F,Yang H,Guo Z,et al.Derivation and validation of prognostic models for predicting survival outcomes in Acute-on-chronic liver failure patients. J Viral Hepat, 2021, 28(12):1719-28.
[17] Moreau R,Claria J, Aguilar F,et al. Blood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF.J Hepatol, 2020,72(4):688-701.
[18] Dong V, Nanchal R, Karvellas CJ. Pathophysiology of acute liver failure. Nutr Clin Pract, 2020, 35(1):24-29.
[19] 邓珂欣,罗红春.常用血液学指标评定慢加急性肝衰竭患者并发细菌感染和预后价值研究.实用肝脏病杂志.2023,26(2):242-245.
[20] Scheiner B, Semmler G, Maurer F, et al. Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease. Liver Int,2020,40(1): 194-204.

Subjective global assessment and global leaders malnutrition initiative standards in the assessment of malnutrition in patients with liver failure

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