The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-24 DOI:10.1016/j.clnesp.2025.03.027

Chattarin Pumtako , Ross D. Dolan , Marie Fallon , Erin S. Sullivan , Claribel Pl Simmons , Aoife M. Ryan , Josh McGovern , Derek G. Power , Barry J. Laird , Donald C. McMillan

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Abstract

Background

The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.

Methods

This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan–Meier survival analyses.

Results

CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05).

Conclusion

Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.

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全球营养不良领导倡议（GLIM）炎症标准预测晚期癌症患者的生存：一项前瞻性队列研究

全球营养不良领导倡议（GLIM）标准为评估癌症患者的恶病质提供了一个框架。然而，全身性炎症在这一框架中的作用需要进一步探索。方法本研究分析了来自18个肿瘤护理机构的388例晚期癌症患者。c反应蛋白（CRP）、改良格拉斯哥预后评分（mGPS）和中性粒细胞与淋巴细胞比值（NLR）用于评估全身炎症。使用卡方和Kaplan-Meier生存分析评估这些炎症标志物与体重减轻（WL）、体重指数（BMI）、骨骼肌指数（SMI）和生存结果（OS）之间的关系。结果scrp与ECOG-PS显著相关(p <；0.01), WL (p <；0.05)。mGPS与ECOG-PS显著相关(p <；0.001), WL (p <；0.001), BMI (p <；0.05)。NLR与ECOG-PS显著相关(p <；0.05), WL (p <；0.001), BMI (p <；0.05)。CRP (p <；0.001), mGPS (p <；0.001), NLR (p <；0.001), WL (p <；0.001)和重度精神分裂症(p <；0.05)与OS显著相关，而与BMI无显著相关（p = 0.23）。CRP、mGPS、NLR与WL、BMI和SMI联合使用可显著改善OS预测。NLR<患者WL与OS显著相关；3 (p <；0.05)，但CRP≤10mg /L或mGPS = 0时则不然。在mGPS = 0的患者中，SMI与OS显著相关(p <；0.05)。结论CRP、mGPS和NLR评估的全身性炎症显著改善了表型标准与OS的关系。这些发现支持了GLIM框架将全身性炎症作为一个关键因素。鉴于其强大的预测价值，在癌症患者的常规临床评估中应优先考虑全身性炎症，mGPS在GLIM框架内具有更大的预后价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.