Validação do Global Leadercship Initiative on malnutrition (GLIM) em pessoas vivendo com HIV/AIDS

Abstract

Introduction: The (Global Leadership Initiative on Malnutrition) (GLIM) committee has representatives from several world nutrition societies and aims to create a consensus on the diagnosis of malnutrition worldwide. Because it is an expert opinion, the GLIM criteria need to undergo validation studies, comparing with methods considered gold or semi-gold standard. The Subjective Global Assessment (SGA) was considered in this study as a semi-gold standard. People living with HIV/AIDS (PLWHA) are potentially prone to malnutrition, hence the importance of testing the validity of the GLIM in this population. Background and Purpose: Studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria for people living with HIV/AIDS (PLWHA) are limited. The aim of this study is to validate the GLIM criteria, using different combinations to diagnose malnutrition in PLWHA, comparing with SGA, evaluating its predictive value for mortality and length of stay. Methods: Retrospective observational study including hospitalized adult PLWHA. Clinical data and nutritional status were evaluated. Different phenotypic and etiological criteria provided 40 different GLIM combinations. Sensitivity (SE), specificity (SP) and concordance (kappa) were tested. Prediction of mortality and length of stay by logistic and Cox regression analyses. Results: 320 patients were included [mean age 44.6 (±12.1) years, 69.1% male and 68.4% malnourished according to AGS]. The prevalence of malnutrition according to the GLIM criteria ranged from 10.3% to 69.1%. The combinations of weight loss (WL) and/or low BMI (LBMI) and/or reduced muscle mass (RMM) + reduced intake (RI) (RR: 2.09; 95%CI: 1.15-3.77) and WL and/or LBMI and/or RMM + OD (opportunistic disease) (RR: 2.09; 95%CI 1.25-3.51) were independent predictors of mortality. The combination LBMI + reduced absorption (RA) was independently associated with longer hospital stay (RR:2.57; 95%CI:1.21-5.45). Conclusion: Nine GLIM criteria combinations achieved the SE and SP metrics for concurrent validation and two were independent predictors of mortality and one for length of stay. The combination of WL and/or LBMI and/or RMM + RI reached the expected values for both concurrent validity and predictive validity of mortality in PLWHA.