Global Leadership Initiative on Malnutrition as a predictor of mortality and prolonged hospitalization in emergency department patients: A prospective cohort study

Abstract

Background: Early diagnosis of malnutrition is essential for rapid decision-making regarding nutrition care to improve patient outcomes. We aimed to evaluate the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess the association of GLIM with 1-year mortality and length of hospital stay (LOS) in patients admitted to an emergency department (ED). Methods: Prospective cohort study conducted in the ED of a university hospital. Nutrition assessment included anthropometry, Subjective Global Assessment (SGA), and GLIM criteria. The receiver operating characteristic curves and logistic regression were used for analysis. Results: The SGA identified 53.9% of patients as malnourished and the GLIM criteria, 50.9%. GLIM showed good accuracy compared with the SGA, with an area under the curve (86.8%) and high sensitivity (84.8%) and specificity (88.8%) values. Malnutrition assessed by SGA demonstrated predictive validity for LOS (odds ratio [OR] = 2.2, 95% CI: 1.4–3.2; P < 0.001) and 1-year mortality (OR = 8.7; 95% CI: 4.3–17.7; P < 0.001). Similarly, malnutrition identified by GLIM increased the risk of LOS (OR = 2.2, 95% CI: 1.3–3.9; P = 0.007) and 1-year mortality (OR = 6.7, 95% CI: 3.6–12.5; P < 0.001). Conclusion: GLIM criteria and SGA demonstrated predictive power for LOS and 1-year mortality. However, the GLIM criteria stand out for adopting more objective and standardized criteria, making it a viable and reproducible approach for diagnosing malnutrition in ED patients.