GLIM标准诊断的营养不良与溃疡性结肠炎住院患者疾病活动度及不良临床结局的关系

Association of malnutrition based on Global Leadership Initiative on Malnutrition criteria with the disease activity and adverse clinical outcomes in hospitalized ulcerative colitis patients

目的探讨以全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)诊断的营养不良与溃疡性结肠炎(ulcerative colitis,UC)住院患者疾病活动度及不良临床结局的关系。方法前瞻性纳入青岛大学附属医院2019年9月至2023年3月的115例UC住院患者,应用GLIM及欧洲临床与代谢营养学会(European society for clinical nutrition and metabolism,ESPEN)2015标准进行营养不良诊断,分析两种诊断标准的一致性。根据GLIM将UC住院患者分为营养不良组和非营养不良组,进一步研究GLIM诊断的营养不良与疾病活动度及不良临床结局的关系,采用二元Logistic回归,探讨UC住院患者不良临床结局的影响因素。结果GLIM与ESPEN 2015标准具有较好的相关性和高度一致性(AUC=0.875,P<0.001;K=0.809,P<0.001)。根据GLIM标准,UC住院患者营养不良的患病率为32.17%(37例),与非营养不良组相比,营养不良组UC住院患者改良Mayo评分及C反应蛋白更高(P均<0.05)、重度疾病活动期患者比例更高(P=0.005)。营养不良组UC患者住院天数更长(P<0.001)、住院费用更高(P<0.001),12周及54周药物升级/转化治疗、再入院及手术患者比例更高(P<0.05)。二元Logistic回归分析结果显示,高Mayo评分(OR=3.606,P=0.016)、高改良Mayo评分(OR=1.346,P=0.009)及营养不良(OR=1.430,P=0.012)是UC住院患者12周不良临床结局的独立危险因素;高Mayo评分(OR=6.491,P=0.011)及营养不良(OR=6.693,P=0.033)是UC住院患者54周不良临床结局的独立危险因素。结论GLIM与ESPEN 2015标准诊断UC住院患者营养不良具有高度一致性;合并营养不良的UC住院患者病情更重;营养不良可预测UC住院患者不良临床结局,是影响UC住院患者不良临床结局的独立危险因素。

Objective To investigate the association of malnutrition based on Global Leadership Initiative on Malnutrition(GLIM)criteria with the disease activity and clinical outcomes in hospitalized ulcerative colitis(UC)patients.Methods Clinical data of 115 patients with UC hospitalized in the Affiliated Hospital of Qingdao University from September 2019 to March 2023 were prospectively analyzed.GLIM and European Society for Clinical Nutrition and Metabolism(ESPEN)2015 criteria were used for the diagnosis of malnutrition,allowing the analysis of consistency between two diagnostic criteria for malnutrition.The relationship between malnutrition based on GLIM criteria and disease activity and clinical outcome was further investigated.The risk factors of adverse clinical outcomes in UC patients were analyzed using binary logistic regression.Results GLIM and ESPEN 2015 diagnostic criteria showed high correlation and consistency(AUC=0.875,P<0.001;K=0.809,P<0.001).According to GLIM criteria,the prevalence of malnutrition among hospitalized UC patients was 32.17%(37 cases).Compared with non-malnourished UC patients,the modified Mayo score and C-reactive protein level of malnutrition patients were higher(P<0.005),and the proportion of patients with severe disease activity was higher(P=0.005).UC patients in the malnourished group had longer hospital stay(P<0.001),higher hospitalization costs(P<0.001),and higher rates of drug escalation/conversion therapy,re-admission and surgery at 12 weeks and 54 weeks(P<0.05).Binary logistic regression analysis showed that a high Mayo score(OR=3.606,P=0.016),a high modified Mayo score(OR=1.346,P=0.009)and malnutrition(OR=1.430,P=0.012)were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 12 weeks.A high modified Mayo score(OR=6.491,P=0.011)and malnutrition as per GLIM criteria(OR=6.693,P=0.033)were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 54 weeks.Conclusions GLIM and ESPEN 2015 diagnostic criteria show high consistency in the diagnosis of malnutrition in hospitalized UC inpatients.Malnutrition may imply adverse clinical outcomes of hospitalized UC patients,which is an independent risk factor for the adverse clinical outcome of hospitalized UC patients.