Vascular Surgery Patients at Risk for Malnutrition Are at an Increased Risk of Developing Postoperative Complications

Beek, Lies ter; Moumni, Mostafa El; Visser, Linda; Zeebregts, Clark J.; Jager‐Wittenaar, Harriët; Pol, Robert A.

doi:10.1016/j.avsg.2019.10.037

Cited by 34 publications

(33 citation statements)

References 37 publications

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“…PG-SGA is an instrument to diagnose malnutrition and has been used in oncology, acute medical, surgical, and elderly patients. 3,[7][8][9][10] Scores range from 0 to 52, and patients were considered malnourished with a score !9. 3…”

Section: Measurementsmentioning

confidence: 99%

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

IJmker-Hemink¹,

Heerschop²,

Wanten³

et al. 2022

Journal of the Academy of Nutrition and Dietetics

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Background The Global Leadership Initiative on Malnutrition (GLIM) approach to diagnose malnutrition was published in 2018. An important next step is to use the GLIM criteria in clinical investigations to assess their validity and feasibility.Objective To compare the validity and feasibility of the GLIM criteria with Patient-Generated Subjective Global Assessment (PG-SGA) in hospitalized patients and to assess the association between malnutrition and 1-year mortality.Design Post hoc analysis of a prospective cohort study. Participants/setting Hospitalized patients (n ¼ 574) from the Departments of Gastroenterology, Gynecology, Urology, and Orthopedics at the Radboudumc academic facility in Nijmegen, The Netherlands, were enrolled from July 2015 through December 2016. Main outcome measuresThe GLIM criteria and PG-SGA were applied to identify malnourished patients. Mortality rates were collected from electronic patient records. Feasibility was assessed by evaluating the amount of and reasons for missing data.Statistical analyses performed Concurrent validity was evaluated by assessing the sensitivity, specificity, and Cohen's kappa coefficient for the GLIM criteria compared with PG-SGA. Cox regression analysis was used for the association between the GLIM criteria and PG-SGA and mortality. ResultsOf 574 patients, 160 (28%) were classified as malnourished according to the GLIM criteria and 172 (30.0%) according to PG-SGA (k ¼ 0.22, low agreement). When compared with PG-SGA, the GLIM criteria had a sensitivity of 43% and a specificity of 79%. Mortality of malnourished patients was more than two times higher than for nonmalnourished patients according to the GLIM criteria (hazard ratio [HR], 2.68; confidence interval [CI], 1.33-5.41). Data on muscle mass was missing in 454 of 574 (79%) patients because of practical problems with the assessment using bioimpedance analysis (BIA).Conclusions Agreement between GLIM criteria and PG-SGA was low when diagnosing malnutrition, indicating that the two methods do not identify the same patients. This is supported by the GLIM criteria showing predictive power for 1-year mortality in hospitalized patients in contrast to PG-SGA. The assessment of muscle mass using BIA was difficult to perform in this clinical population.

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Section: Measurementsmentioning

confidence: 99%

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

IJmker-Hemink¹,

Heerschop²,

Wanten³

et al. 2022

Journal of the Academy of Nutrition and Dietetics

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“…The PG-SGA SF is part of the Full PG-SGA, which is well-implemented as a reference tool in the oncology setting and is increasingly used in hospitals worldwide [19,20]. The PG-SGA SF has been validated as a separate tool for malnutrition screening in cancer in-and outpatients, patients with chronic kidney disease and patients prior to vascular surgery, against accepted nutritional assessment instruments such as the Subjective Global Assessment (SGA) or in association with patient outcomes such as post-operative complications [21][22][23][24][25][26][27]. To our knowledge, the potential role of the PG-SGA SF in malnutrition screening in a mixed hospital population, with a specific focus on its performance in overweight and obese patients, has not been explored previously.…”

Section: Introductionmentioning

confidence: 99%

Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF

et al. 2021

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Background/objectives Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients. Subjects/methods We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2. Results Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. Conclusions More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.

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“…The PG-SGA SF thereby generates a score ranging from 0 to 36. Based on the PG-SGA SF score, patients were categorized as having low risk (PG-SGA SF score 0e3), medium risk (PG-SGA SF score 4e8), or high risk (PG-SGA SF score 9) of malnutrition [24].…”

Section: Malnutrition Risk Screeningmentioning

confidence: 99%

“…Also, it is suitable for selfcompletion by the patient, with most patients being able to complete the PG-SGA SF in less than 5 min [20,21]. Thus far, the PG-SGA SF has been validated against the full PG-SGA in cancer outpatients receiving chemotherapy [22,23], and has been associated with a higher risk of post-operative complications in vascular surgery patients independent of other characteristics such as age, sex, and BMI [24].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients

Gomes-Neto

Vliet

Osté

et al. 2021

Clinical Nutrition ESPEN

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Background and aims: Malnutrition screening is a first step in the nutrition care process for hospitalized patients, to identify those at risk of malnutrition and associated worse outcome, preceding further assessment and intervention. Frequently used malnutrition screening tools including the Malnutrition Universal Screening Tool (MUST) mainly screen for characteristics of malnutrition, while the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) additionally includes risk factors for development of malnutrition, yielding a higher percentage of patients at risk. To investigate whether this translates into higher risk of worse outcome, we aimed to determine the predictive validity of MUST and PG-SGA SF for prolonged hospitalization >8 days, readmission, and mortality <6 months after hospital discharge. Methods: In this observational study, MUST was performed according to university hospital protocol. Additional screening using PG-SGA SF was performed within 24 h of hospital admission (high risk: MUST 2, PG_SGA SF 9). Associations of MUST and PG-SGA SF with outcomes were analyzed by logistic-and Cox PH-regression. Results: Of 430 patients analyzed (age 58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m 2 ), MUST and PG-SGA SF identified 32 and 80 at high risk, respectively. One-hundred-eight patients had prolonged hospitalization, 109 were readmitted and 20 died. High risk by MUST was associated with mortality (HR ¼ 3.9; 95% CI 1.3e12.2, P ¼ 0.02), but not with other endpoints. High risk by PG-SGA SF was associated with prolonged hospitalization (OR ¼ 2.5; 95% CI 1.3e5.0, P ¼ 0.009), readmission (HR ¼ 1.9; 95% CI 1.1e3.2, P ¼ 0.03), and mortality (HR ¼ 34.8; 95% CI 4.2e289.3, P ¼ 0.001), independent of age, sex, hospital ward and previous hospitalization <6 months. In the 363/430 patients classified as low risk by MUST, high risk by PG-SGA SF was independently associated with higher risk of readmission (HR ¼ 1.9; 95% CI 1.0e3.5, P ¼ 0.04) and mortality (HR ¼ 19.5; 95% CI 2.0e189.4, P ¼ 0.01). Conclusions: Whereas high malnutrition risk by MUST was only associated with mortality, PG-SGA SF was associated with higher risk of prolonged hospitalization, readmission, and mortality. In patients considered as low risk by MUST, high malnutrition risk by PG-SGA SF was also predictive of worse outcome. Our findings support the use of PG-SGA SF in routine care to identify patients at risk of malnutrition and worse outcome, and enable proactive interventions.

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Vascular Surgery Patients at Risk for Malnutrition Are at an Increased Risk of Developing Postoperative Complications

Cited by 34 publications

References 37 publications

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF

Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients

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