Validity of the GLIM criteria using calf circumference in the prediction of in-hospital mortality in older surgical patients: A secondary analysis of a cohort study.

Abstract

Malnutrition is a prevalent condition among older patients and is associated with worse clinical outcomes. Methods such as the Subjective Global Assessment (SGA), the Mini Nutritional Assessment Long Form (MNA-LF), and the Global Leadership Initiative on Malnutrition (GLIM) diagnose malnutrition early. This study aimed to evaluate the performance and validity of these instruments to predict the length of hospital stay (LOS) and in-hospital mortality in older surgical patients. This prospective cohort study was performed with hospitalized older surgical patients. In the first 48 hours of admission, general data were collected, and patients were evaluated by SGA, MNA-LF, and GLIM using calf circumference (CC) and mid-upper arm circumference (MUAC) as phenotypic criteria for nutritional diagnoses. Accuracy tests and regression analysis adjusted for sex, type of surgery, and the Charlson Comorbidity Index adjusted for age were performed to assess the criterion validity of instruments to predict LOS and mortality. 214 surgical patients (75.4 ± 6.6 years old; 57.3% men, and 71.1% admitted to elective surgery) were evaluated. Malnutrition was diagnosed in 39.7% (SGA), 63% (MNA-LF), 41.6% (GLIMCC ), and 32.1% (GLIMMUAC ) of patients. GLIMCC had the best accuracy (AUC = 0.70; 95%CI 0.63-0.79) and sensitivity (95.8%) to predict in-hospital mortality. In the adjusted analysis, malnutrition, according to SGA, MNA-LF, and GLIMCC , increased the risk of in-hospital mortality by 3.12 [95%CI (1.08-11.34)], 4.51 [95%CI (1.29-17.61), and 4.83 [95%CI (1.52-15.22)], respectively. GLIMCC had the best performance and satisfactory criterion validity to predict in-hospital mortality in older surgical patients. This article is protected by copyright. All rights reserved.