Applicability and predictive validity of the global leadership initiative on malnutrition criteria for older patients with sepsis according to different muscle mass assessment methods

IF 4 3区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Nutrition Health & Aging Pub Date : 2025-09-19 DOI:10.1016/j.jnha.2025.100685

Na Shang , Qiujing Li , Haijing Zhou , Xiangqun Zhang , Shubin Guo , Xue Mei

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引用次数: 0

Abstract

Objectives

To evaluate the applicability of the Global Leadership Initiative on Malnutrition (GLIM) criteria in older patients with sepsis and to compare the predictive validity for 28-day mortality of different muscle mass assessment methods in the emergency department.

Design

Prospective cohort study.

Setting

Emergency department.

Patients

Older patients (≥65 years) with sepsis.

Measurements

Muscle mass was assessed using three methods: (1) the skeletal muscle index at the third lumbar vertebra (L3) on computed tomography (CT) scans; (2) calf circumference (CC), and (3) mid-upper-arm circumference (MAC). Cox regression analysis was performed to assess the association between the GLIM criteria and 28-day all-cause mortality. Additionally, the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the predictive validity of the three instruments. Survival curves were assessed using the Kaplan–Meier method and compared using the log-rank test.

Results

A total of 598 patients with sepsis were included. The prevalence of malnutrition according to GLIM-CT, GLIM-CC, and GLIM-MAC was 53.3%, 63.0%, and 40.8%, respectively. Cox regression analysis revealed that the GLIM criteria were independent risk factors for all-cause 28-day mortality. Incorporation of GLIM-CT, GLIM-CC, or GLIM-MAC into a base model significantly improved the C-statistic. The model including GLIM-CT had the highest C-statistic, improving the C-statistic of the base model from 0.780 (95% confidence interval [CI]: 0.741−0.819) to 0.823 (95% CI: 0.789−0.857). This improvement in risk prediction was also confirmed via category-free NRI and IDI, suggesting that GLIM-CT had the best performance. Kaplan–Meier survival analysis showed that patients with malnutrition defined according to the GLIM criteria had a greater probability of 28-day mortality (log-rank, P < 0.001).

Conclusion

Malnutrition, defined via any of the three methods, was predictive of 28-day mortality among older patients with sepsis in the emergency department. GLIM-CT had the best predictive validity.

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根据不同肌肉质量评估方法，全球领导力倡议对老年脓毒症患者营养不良标准的适用性和预测有效性

目的评价全球营养不良领导倡议（Global Leadership Initiative on nutrition， GLIM）标准在老年脓毒症患者中的适用性，并比较不同肌肉质量评估方法在急诊科对28天死亡率的预测效度。前瞻性队列研究。SettingEmergency部门。患者（≥65岁）败血症患者。测量采用三种方法评估肌肉质量：(1)计算机断层扫描（CT）第三腰椎（L3）骨骼肌指数；(2)小腿围（CC）和(3)中上臂围（MAC）。采用Cox回归分析评估GLIM标准与28天全因死亡率之间的关系。此外，采用c统计量、净重分类改善（NRI）和综合区分改善（IDI）来评估三种工具的预测效度。使用Kaplan-Meier法评估生存曲线，并使用log-rank检验进行比较。结果共纳入598例脓毒症患者。根据格利姆- ct、格利姆- cc和格利姆- mac，营养不良发生率分别为53.3%、63.0%和40.8%。Cox回归分析显示，GLIM标准是全因28天死亡率的独立危险因素。将gim - ct、gim - cc或gim - mac纳入基础模型可显著提高c统计量。包含glimm - ct的模型c -统计量最高，将基础模型的c -统计量从0.780（95%置信区间[CI]: 0.741−0.819）提高到0.823（95%置信区间[CI]: 0.789−0.857）。通过无分类NRI和IDI也证实了这种风险预测的改善，表明gim - ct具有最佳性能。Kaplan-Meier生存分析显示，根据GLIM标准定义的营养不良患者28天死亡率更高（log-rank, P < 0.001）。结论：通过三种方法中的任何一种定义的营养不良可预测急诊科老年败血症患者28天死亡率。预测效度最佳。

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

Journal of Nutrition Health & Aging 医学-老年医学

CiteScore

7.80

自引率

3.40%

发文量

136

审稿时长

4-8 weeks

期刊介绍： There is increasing scientific and clinical interest in the interactions of nutrition and health as part of the aging process. This interest is due to the important role that nutrition plays throughout the life span. This role affects the growth and development of the body during childhood, affects the risk of acute and chronic diseases, the maintenance of physiological processes and the biological process of aging. A major aim of "The Journal of Nutrition, Health & Aging" is to contribute to the improvement of knowledge regarding the relationships between nutrition and the aging process from birth to old age.