Evaluation And Prediction Of GLIM Consensus On Malnutrition And Hospital-related Health Outcomes In Patients With Gastric Cancer

Background:The high incidence of malnutrition in gastric cancer patients,especially preoperative malnutrition,is more likely to lead to adverse hospital-related health outcomes.Nutritional care can improve malnutrition and is an important treatment for malnutrition.Currently,the false positive results of nutritional risk screening led by nurses are high in clinic,which can not provide clear support for nutritional care,this requires more accurate assessment of malnutrition by the nursing staff to identify malnutrition in a real and timely manner.The global parenteral and Enteral Nutrition Society developed and recommended “The Global Leadership Initiative on Malnutrition Criteria for the Diagnosis of Malnutrition”(GLIM)as the first globally harmonized and simple assessment tool for malnutrition,it needed to be further validated as it is based entirely on expert consensus.Due to the fact that the current research to validate the GLIM standard is mainly retrospective research,there may be shortcomings such as incomplete data collection,and the specific application content of the GLIM standard in different studies is different.In the etiological criteria,there are disputes about whether all cancer patients meet reduced food intake or absorption disorders,or inflammation or disease burden,which is directly related to the work content of clinical nursing personnel,It affects the accuracy of the incidence of malnutrition assessment,which in turn affects the development and implementation of nutritional care plans.Only accurate malnutrition assessment results can provide a clear and reliable basis for nutritional care.Therefore,it is necessary to clarify and standardize the specific measures for the application of the GLIM standard in the etiology of gastric cancer patients,ensure the accuracy of the GLIM standard,facilitate nursing personnel to quickly and accurately identify malnourished gastric cancer patients before surgery,provide protection for timely nutritional care for malnourished patients,help patients improve their nutritional status,and further improve hospital related health outcomes.Objective:Compared with Patient generated subjective global assessment(PG-SGA),which is recognized as the“Semi-gold standard” for malnutrition assessment,to compare the prevalence of malnutrition in gastric cancer patients with the same phenotype criteria and different etiologic criteria based on GLIM criteria,and to explore the different etiologic criteria based on the same phenotype criteria and different etiologic criteria based on Glim criteria,differences in hospital-related health outcomes between malnourished and non-malnourished patients,validation of the simultaneous validity and predictive validity of the GLIM criteria,and specification of the implementation of the etiologic criteria in the Glim criteria;To ensure the accuracy of evaluation of malnutrition by GLIM standard,and to provide practical basis for nurses to evaluate malnutrition.Methods:This study is a prospective observational study.The subjects of the study were 159 patients who underwent radical surgery for gastric cancer in the Department of Gastrointestinal Surgery of a Class III Hospital in Changchun City,Jilin Province from December 2021 to December 2022.(1)Part I: To verify the simultaneous validity of the GLIM standard.The nutritional risk screening tool NRS2002 recommended by CSPEN was used to conduct nutritional risk screening for gastric cancer patients undergoing gastrectomy within 24 hours after admission;Malnutrition was evaluated within 48 hours using PG-SGA and GLIM standards for gastric cancer patients with NRS2002 ≥ 3 points who underwent gastrectomy.The differences between different nutritional evaluation methods were compared to verify the simultaneous validity of GLIM standards.(2)Part II: Verifying the predictive validity of the GLIM standard.To investigate clinical outcome indicators such as major complications within 30 days after surgery,mortality within 30 days after surgery,and readmission rate within 30 days in patients with gastric cancer,explore the differences in hospital health outcomes between malnourished and non malnourished patients using the same phenotypic criteria based on GLIM standards,and verify the predictive validity of GLIM standards.Data were entered using Excel software and analyzed using SPSS26.0 statistical software.Descriptive statistics were used to analyze the basic situation of patients.In order to facilitate statistical analysis,this study named the first group-all patients with gastric cancer who met the etiological criteria,and those who met any phenotypic criteria as malnutrition,GLIM1;The second group-based on the actual situation of patients with gastric cancer,patients with gastric cancer who simultaneously meet any phenotypic criteria and any etiological criteria are known as malnutrition,and are named GLIM2.Cohens Kappa coefficient was used to test the consistency and compare the simultaneous validity of GLIM1,GLIM2,and PG-SGA in assessing whether gastric cancer patients have malnutrition.Spearman correlation analysis was conducted between GLIM1 and GLIM2 and hospital related health outcomes,respectively.At the same time,ROC curves and logistic regression models were used to analyze hospital related health outcomes to test the predictive validity of GLIM standards.P<0.05 is considered statistically significant.Results:(1)Demographic and disease characteristics of the subjects: The average age of the patients was 62.3 ± 9.7 years old,including 103 male patients(64.8%).Driven by the concept of enhanced recovery after surgery(ERAS)in hospitals,128 patients(80.5%)underwent laparoscopic surgery.According to surgical classification,94 cases(59.1%)underwent distal gastrectomy,19 cases(11.9%)underwent proximal gastrectomy,and 46 cases(28.9%)underwent total gastrectomy.(2)Results of malnutrition assessment of the subjects: When NRS2002 score ≥ 3,GLIM1 was used to assess preoperative malnutrition.Among them,81 patients(50.9%)had malnutrition and 78 patients(42.1%)had non malnutrition.When the NRS2002 score was ≥ 3,GLIM2 was used to assess preoperative malnutrition.Among them,67patients(42.1%)had malnutrition and 92 patients(57.9%)had non malnutrition.(3)Status of hospital related health outcomes of the study subjects: In this study,159 patients with gastric cancer did not experience death during hospitalization and within 30 days of follow-up after discharge.There were 13 cases of complications 30 days after surgery.According to the GLIM1 standard,there were 3 cases(1.9%)and10 cases(6.3%)of postoperative complications at 30 days in the malnutrition group and the non malnutrition group,respectively(p=0.011<0.05),with statistical differences.The number of re admissions within 30 days after discharge was 15.According to the GLIM1 standard,there were 3 cases(1.87%)in the malnutrition group and 10 cases(6.3%)in the non malnutrition group,respectively(p=0.011<0.05),with a statistically significant difference.There were no statistical differences among the others.(4)Comparing the effects of GLIM1 and GLIM2 on the assessment of malnutrition in research subjects: Compared with PG-SGA,the consistency of GLIM1 in assessing preoperative malnutrition was 0.906(sensitivity=0.859,specificity=0.970,Kappa(95% CI)=0.811,P<0.001),with a statistical difference.Compared with PGSGA,the consistency of GLIM2 in assessing preoperative malnutrition was 0.717(sensitivity=0.886,specificity=0.744,Kappa(95% CI)=0.361(0.352,0.580),P<0.001),with a statistically significant difference.(5)The relationship between nutritional status and hospital related health outcomes in research subjects: In multivariate analysis,the impact of malnutrition assessed by the GLIM1 standard on postoperative complications at 30 days was statistically significant(OR=5.971,95% CI 1.279-27.888,p<0.05).The effect of malnutrition assessed by GLIM1 on the readmission rate 30 days after discharge was statistically significant(OR=5.971,95% CI 1.279-27.888,p<0.05).There were no statistical differences among the others.Conclusions:The GLIM1 standard is a reliable tool for assessing malnutrition in gastric cancer patients and predicting hospital related health outcomes-postoperative complications at 30 days and readmission rates within 30 days after discharge.At the same time,using the GLIM standard in gastric cancer patients only needs to pay attention to the phenotype standard.The content of malnutrition assessment is simple,objective,easy to understand,and highly feasible,which simplifies the complexity of malnutrition assessment and reduces the workload of clinical nurses to a certain extent.