Clinical Course and Prognosis of the Global Leadership Initiative on Malnutrition-Defined Malnutrition in Critically Ill Patients with Sepsis: A Multicenter Prospective Observational Study.

Abstract

Introduction: Sepsis is a critical condition with a high nutritional risk and mortality. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed for diagnosing malnutrition, their clinical relevance in sepsis remains unclear. Therefore, we conducted a descriptive study on GLIM-defined malnutrition in intensive care unit (ICU) patients with sepsis to investigate its clinical course and prognosis.

Methods: This was a multicenter prospective study conducted at 15 centers. Malnutrition was identified at ICU admission when both phenotypic and etiologic criteria were present. The primary outcome was a composite of in-hospital mortality or a decline in activities of daily living (Barthel Index <90) at discharge. Secondary outcomes included ICU length of stay, use of parenteral nutrition, and days to achievement of each ICU Mobility Scale level.

Results: Among 254 patients, 106 (41.7%) had malnutrition. The malnutrition group showed a significantly higher occurrence of the composite of in-hospital mortality and Barthel index <90 (76.4% vs. 64.2%, p = 0.04) and had significantly longer ICU stays (7 vs. 5, p = 0.001). Total nutrition delivery did not significantly differ between groups, while a higher percentage of patients in the malnutrition group received parenteral nutrition (57.6% vs. 43.2%, p = 0.02). Significant delays in achieving higher mobility levels were observed in the malnutrition group.

Conclusion: GLIM-defined malnutrition in patients with sepsis was significantly associated with the composite outcome of in-hospital mortality or Barthel index <90 at discharge. These results suggest the clinical importance of an early GLIM assessment after ICU admission.