The GLIM criteria for adult malnutrition and its relation with adverse outcomes, a prospective observational study

Abstract

Background & aims: Malnutrition is considered a risk factor for many complications and mortality among hospitalized patients. Until 2016 there was a wide variety of clinical definitions for malnutrition, until the GLIM criteria proposed a consensual definition. The main goal of this study is to assess the performance of the GLIM criteria at acute care admission to detect those patients with adverse clinical outcomes such as mortality and the need to be transferred to critical care areas (CCA).

Methods: This was a prospective observational study including every adult patient admitted to the regular ward of the Hospital San Ángel Inn Universidad. Every nutrition and demographic variable evaluated by the nutrition team at hospital admission was captured. The malnutrition definition according to the GLIM and separate criteria were tested for their performance to detect patients at high risk for adverse outcomes (mortality and the need to be transferred to CCA), using odd ratios (OR), their confidence interval of 95% (CI95%) and binary logistic regression accordingly.

Results: A total of 1015 patients were included in the final analysis, with a prevalence of 18.9% of malnutrition (according to the GLIM definition) at hospital admission. Malnutrition was associated with mortality (OR of 59.69,CI95% 7.76-459.28) and unplanned transfer to CCA (OR of 9.453, CI95%4.35-20.56). However, despite being sensitive, the GLIM definition of malnutrition, displayed low positive predictive value, and was therefore associated with many false positives. There was a trend for higher risks for adverse outcomes with higher severity of malnutrition. Muscle wasting, chronic and acute inflammation were independent predictors for mortality and for unplanned transfer to CCA.

Conclusions: Malnutrition according to the GLIM criteria is strongly associated with mortality and transfer to CCA. Muscle wasting and inflammation (acute and chronic) were independently associated with these outcomes.

Keywords: Adult malnutrition; GLIM criteria; Hospital malnutrition.