Clinical nutrition ESPEN · 2026
Prognostic value of GLIM criteria with and without inflammation assessment in older patients with heart failure: FRAGILE-HF cohort.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Matsuo Koji, Kamiya Kentaro, Maeda Daichi, Hamazaki Nobuaki, Uchida Shota, Yamashita Masashi, Konishi Masaaki, Kasai Takatoshi, Saito Hiroshi, Ogasahara Yuki, Kitai Takeshi, Iwata Kentaro, Jujo Kentaro, Wada Hiroshi, Maekawa Emi, Momomura Shin-Ichi, Kagiyama Nobuyuki, Matsue Yuya
Аннотация
BACKGROUND AND AIMS: Malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria is frequent in older patients with heart failure (HF) and is associated with poor outcomes. It is uncertain whether specifying inflammation with C-reactive protein (CRP) thresholds adds prognostic value beyond the application of the GLIM criteria in HF. The purpose of this study was to examine whether adding CRP-based inflammation criteria to the GLIM criteria would improve prediction of all-cause mortality.
METHODS: We performed a post hoc analysis of the prospective multicenter FRAGILE-HF cohort, which enrolled consecutive patients aged ≥65 years who were hospitalized with HF. Malnutrition was defined using standard GLIM criteria in which HF was assumed to satisfy the inflammation component of the etiologic criterion in all patients. We also evaluated four modified GLIM criteria in which malnutrition required at least one phenotypic criterion and an etiologic criterion met by reduced food intake or inflammation, with the inflammation component operationalized as CRP at discharge of at least 1.0, 3.0, 5.0, or 10.0 mg/L. The primary outcome was 2-year all-cause mortality after discharge.
RESULTS: Of 1332 enrolled patients, 835 were analyzed (median [interquartile range] age, 81 years [74-86 years], 58.2% men). Malnutrition was associated with higher mortality for the standard GLIM criteria (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.19-2.32) and for modified criteria with CRP ≥1.0 mg/L (HR 1.59, 95% CI 1.15-2.21), ≥3.0 mg/L (HR 1.47, 95% CI 1.06-2.03), ≥5.0 mg/L (HR 1.45, 95% CI 1.05-2.01), and ≥10.0 mg/L (HR 1.68, 95% CI 1.21-2.34). The net reclassification improvement and integrated discrimination improvement for models that added each modified GLIM criteria were small and not statistically significant across all CRP thresholds.
CONCLUSION: In older patients with HF, malnutrition defined by the GLIM criteria was associated with 2-year all-cause mortality, and adding CRP-based inflammation thresholds to the GLIM criteria did not improve prognostic discrimination.
CLINICAL TRIAL REGISTRATION: UMIN-CTR (unique identifier: UMIN000023929, Date: 2016/09/05).
METHODS: We performed a post hoc analysis of the prospective multicenter FRAGILE-HF cohort, which enrolled consecutive patients aged ≥65 years who were hospitalized with HF. Malnutrition was defined using standard GLIM criteria in which HF was assumed to satisfy the inflammation component of the etiologic criterion in all patients. We also evaluated four modified GLIM criteria in which malnutrition required at least one phenotypic criterion and an etiologic criterion met by reduced food intake or inflammation, with the inflammation component operationalized as CRP at discharge of at least 1.0, 3.0, 5.0, or 10.0 mg/L. The primary outcome was 2-year all-cause mortality after discharge.
RESULTS: Of 1332 enrolled patients, 835 were analyzed (median [interquartile range] age, 81 years [74-86 years], 58.2% men). Malnutrition was associated with higher mortality for the standard GLIM criteria (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.19-2.32) and for modified criteria with CRP ≥1.0 mg/L (HR 1.59, 95% CI 1.15-2.21), ≥3.0 mg/L (HR 1.47, 95% CI 1.06-2.03), ≥5.0 mg/L (HR 1.45, 95% CI 1.05-2.01), and ≥10.0 mg/L (HR 1.68, 95% CI 1.21-2.34). The net reclassification improvement and integrated discrimination improvement for models that added each modified GLIM criteria were small and not statistically significant across all CRP thresholds.
CONCLUSION: In older patients with HF, malnutrition defined by the GLIM criteria was associated with 2-year all-cause mortality, and adding CRP-based inflammation thresholds to the GLIM criteria did not improve prognostic discrimination.
CLINICAL TRIAL REGISTRATION: UMIN-CTR (unique identifier: UMIN000023929, Date: 2016/09/05).