Applicability analysis of three nutritional assessment tools under GLIM standard in elderly patients with digestive system tumors
Objective To explore the applicability of patient-generated subjective nutrition assessment(PG-SGA),prognostic nutrition index(PNI)and geriatric nutrition risk index(GNRI)in the nutritional assessment of elderly patients with digestive system tumors based on Global Leadership Initiative on Malnutrition criteria(GLIM).Method Elderly patients who underwent digestive system tumor resection in Affiliated Hospital of Xuzhou Medical University from March 2021 to June 2022 were selected.With GLIM as the"gold standard"for the diagnosis of malnutrition,PG-SGA,PNI and GNRI were used for nutritional assessment,and the sensitivity、specificity、positive predictive value and negative predictive value were calculated and compared.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was compared by Delong test to explore the clinical value of each tool comparison between groups was conducted.Result The positive rate of malnutrition diagnosed by GLIM was 29.3％.The positive rates of PG-SGA,PNI and GNRI were 37.0％,44.0％and 45.7％,respectively.The body mass index,muscle loss and phase angle indexes were worse in the patients with malnutrition,and the serum albumin(ALB),prealbumin(PA)and hemoglobin(HB)indexes were decreased,with statistical significance(P＜0.05).Compared with GLIM standard,PG-SGA showed the worst sensitivity(44.1％)and middle specificity(65.9％),with no diagnostic consistency(Kappa=0.09,P=0.311);The sensitivity(61.8％)and specificity(63.4％)of PNI were average,and there was weak agreement with GLIM diagnosis(Kappa=0.22,P=0.013).GNRI had the best specificity(88.2％)and sensitivity(72.0％),and had a good concordance with GLIM diagnosis(Kappa=0.52,P＜0.001).In the ROC curve,GNRI had the highest predictive value(AUC=0.817,95％CI=0.734-0.882),followed by PNI(AUC=0.621,95％CI=0.526-0.709).Delong test showed that the predictive value of GNRI and PG-SGA,GNRI and PNI were statistically significant(Z=3.83,4.85,P＜0.001).The indexes of PA,ALB,TP and HB before、1 day after and 3-5 days after the surgery of the malnourished patients were significantly lower(P＜0.05).In addition,the incidence of surgical site infection(SSI)was also higher in malnourished patients(x2=5.03,P=0.036).Conclusion GNRI has shown good applicability in the nutritional assessment of elderly patients with digestive system tumors.In addition,GNRI may be able to predict a patient's perioperative nutritional status and short-term prognosis.
ElderlyDigestive system tumorsMalnutritionNutritional assessment
万方数据
维普
