全球营养不良领导倡议标准所定义的营养不良阻碍了急诊入院患者的出院回家。

IF 6.6 2区 医学 Q1 NUTRITION & DIETETICS Clinical nutrition Pub Date : 2024-09-27 DOI:10.1016/j.clnu.2024.09.040
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引用次数: 0

摘要

背景和目的:使用全球营养不良领导倡议(GLIM)标准对住院急症患者进行营养不良诊断与患者预后之间的关系证据有限;仍有几个方面需要澄清。本研究旨在评估根据 GLIM 标准定义的急性住院患者营养不良与出院回家之间的关系:这项回顾性观察研究在日本一家提供急症护理的医院进行。研究对象包括 2023 年 7 月至 2024 年 4 月期间入院的成人患者。主要结果是出院回家的患者人数,次要结果是院内死亡率。为确保整个组群结果的可靠性,采用倾向得分匹配法对背景因素进行了调整。根据入院时的 GLIM 标准,对两组患者是否存在营养不良进行了比较。此外,还进行了多元逻辑回归分析,以结果为因变量,以根据 GLIM 标准诊断出的营养不良为解释变量,并对协变量进行了调整:共有 1007 名患者被纳入最终分析,其中 492 人(49%)被诊断为无营养不良,515 人(51%)根据 GLIM 标准被诊断为营养不良。在配对后的多变量逻辑回归分析中,根据 GLIM 标准定义的营养不良成为与出院回家相关的独立因素(几率比 [OR] = 0.37,95 % 置信区间 = 0.25-0.56,P 结论:GLIM 标准与出院回家无关):在一家提供急症护理的地区医院住院的患者,入院时使用 GLIM 标准诊断出的营养不良与出院回家率下降和院内死亡率上升有关。特别需要注意的是,在 GLIM 框架内,肌肉质量减少和疾病负担或炎症的标准。
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Malnutrition defined by global leadership initiative on malnutrition criteria impedes home discharge in acute care hospital admissions

Background & aims

Limited evidence exists on the association between malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospitalized acute care patients and their outcomes; several aspects still require clarification. This study aimed to evaluate the relationship between malnutrition, as defined by the GLIM criteria, at the time of acute hospital admission and discharge to home.

Methods

This retrospective observational study was conducted at a hospital that provides acute care in Japan. Adult patients admitted between July 2023 and April 2024 were included in this study. The primary outcome was the number of patients discharged to home, with in-hospital mortality as the secondary outcome. To ensure the reliability of the cohort-wide results, background factors were adjusted using propensity score matching. The two groups were compared based on the presence or absence of malnutrition, as defined by the GLIM criteria at admission. Furthermore, multiple logistic regression analysis was conducted, with the outcome as the dependent variable and malnutrition, diagnosed using the GLIM criteria, as the explanatory variable, adjusting for covariates.

Results

A total of 1007 patients were included in the final analysis, of whom 492 (49 %) were diagnosed without malnutrition, while 515 (51 %) were diagnosed with malnutrition according to the GLIM criteria. In the multivariate logistic regression analysis after matching, malnutrition defined by the GLIM criteria emerged as an independent factor associated with discharge to home (odds ratio [OR] = 0.37, 95 % confidence interval = 0.25–0.56, P < 0.001) when adjusting for age, sex, and various comorbidities. Among the GLIM sub-criteria, reduced muscle mass, reduced food intake or assimilation, and disease burden or inflammation were independently associated with discharge to home. Notably, disease burden/inflammation exhibited the lowest OR among the GLIM sub-criteria for discharge.

Conclusion

Malnutrition diagnosed using the GLIM criteria upon admission in patients admitted to a regional hospital providing acute care was associated with decreased rates of discharge to home and increased in-hospital mortality. Specifically, attention should be paid to the criteria for reduced muscle mass and disease burden or inflammation within the GLIM framework.
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来源期刊
Clinical nutrition
Clinical nutrition 医学-营养学
CiteScore
14.10
自引率
6.30%
发文量
356
审稿时长
28 days
期刊介绍: Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.
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