Global Leadership Initiative on Malnutrition (GLIM) plus Patient- and Nutrition-Derived Outcome Risk Assessment Score (PANDORA) predicts intensive care mortality: A 180-day follow-up study

Abstract

Background and Aim

Malnutrition is strongly related to mortality in intensive care unit (ICU) patients. The Patient- and Nutrition-Derived Outcome Risk Assessment Score (PANDORA) is a novel mortality prediction tool encompassing nutritional assessment. Since there is limited evidence regarding the power of PANDORA in predicting mortality in critically ill patients, we aimed to evaluate the benefit of adding PANDORA to the Global Leadership Initiative on Malnutrition (GLIM) for mortality prediction in the ICU setting by comparing it with the other valid mortality predictors.

Methods

A total of 251 ICU patients were enrolled in the study. Malnutrition evaluation tools (i.e., GLIM criteria, The nutritional risk screening 2002, The modified Nutrition Risk in Critically Ill score), and mortality/disease severity tools (PANDORA, The Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment) were performed. Scores ≥43 were defined as high PANDORA score.

Results

The median age (IQR) of participants was 67 (52–78) years, and 47.0% (n = 118) were female. Patients were evaluated according to 30th, 60th, 90th, and 180th-day mortalities. In all groups, patients were older, had a lower body mass index and longer hospitalization time, and were more likely to have malnutrition and higher PANDORA, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores. In the Cox regression analyses, even if adjusted for various confounders, malnutrition according to GLIM criteria and a high PANDORA score had the highest hazard ratio (HR) for mortality (HR: 3.62; 95% confidence interval [CI]: 1.49–8.77; P = 0.004, HR: 3.71; 95% CI: 1.69–8.12; P = 0.001, HR: 3.46; 95% CI: 1.69–7.06; P = 0.001 and HR: 4.00; 95% CI: 1.98–8.09; P = 0.004 for 30th, 60th, 90th, and 180th days, respectively).

Conclusions

PANDORA is a valid tool for predicting mortality in ICU patients. Furthermore, to our knowledge this is the first study to reveal that integrating GLIM criteria into PANDORA may enhance its power in this setting.