Prognostic evaluation of GLIM-defined severe malnutrition via skeletal muscle mass index in critically ill adults: A comparative analysis.

Abstract

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended by major academic societies; however, their application to critically ill patients is limited because of the difficulties associated with assessing muscle mass and the lack of standardized methods and cutoff values. We herein applied GLIM criteria to intensive care unit (ICU) patients by accurately assessing total skeletal muscle volume using computed tomography (CT) with sarcopenia diagnostic cutoff values.

Methods: We included consecutive adult patients admitted to our ICU who underwent CT of the trunk. Total skeletal muscle area at the third lumbar vertebra was measured, and the skeletal muscle index was calculated. Reduced muscle mass was defined with Iritani criteria. A positive result in any of the phenotypic criteria was regarded as severe malnutrition. The primary outcome was in-hospital mortality. We also examined the agreement with the Subjective Global Assessment (SGA) using Cohen kappa coefficient.

Results: Among 147 patients, 38 had weight loss, 39 had a low body mass index (BMI), and 41 had reduced muscle mass. In-hospital mortality was associated with reduced muscle mass (13.2% vs 43.9%, P < 0.001) and low BMI (15.7% vs 38.5%, P = 0.003). The concordance of individual and sole phenotypic criteria with SGA was low, whereas concordance was the highest at κ = 0.70 when all three criteria were combined.

Conclusions: GLIM criteria with accurate muscle mass evaluation using sarcopenia diagnostic cutoffs by CT may facilitate the identification of ICU patients with malnutrition whose prognosis is poor.