Prognostic Value of Global Leadership Initiative on Malnutrition in Post-Transjugular Intrahepatic Portosystemic Shunt

Abstract

Abstract Background & Aims: Malnutrition detrimentally impacts the prognosis of patients with cirrhotic portal hypertension (CPH). This study aimed to determine the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its effect on the occurrence of hepatic encephalopathy (HE) post-transjugular intrahepatic portosystemic shunt (TIPS) in patients with CPH. Methods This study incorporated 330 CPH patients who underwent TIPS between December 2015 and March 2022. Employing the GLIM criteria, patients were categorized into normal nutrition, moderate, and severe malnutrition groups. The incidence of HE and survival rates were compared among these groups. A survival prediction nomogram was constructed using individual predictive factors from the GLIM criteria. Results A total of 170 (51.52%) patients were diagnosed with malnutrition [moderate (n = 130) and severe (n = 40)]. Malnutrition correlated with an increased incidence of post-TIPS overt (p < 0.001) and severe HE (p < 0.001) and diminished OS rates (p < 0.0001). Malnutrition based on GLIM criteria was the independent predictor for HE and post-TIPS survival (HR = 1.65, 95%CI: 1.28–2.13, p < 0.001 and HR = 1.65, 95%CI: 1.18–2.29, p = 0.003, respectively). The nomogram, integrating factors including age, ascites, low calibrated body mass index (BMIc), and sarcopenia, demonstrated strong predictive capabilities for post-TIPS survival rates both in the training set (C-index, 0.755, 95%CI: 0.684–0.826) and validation set (C-index, 0.767, 95%CI: 0.613–0.921). Conclusions The GLIM-based diagnosis of malnutrition in patients with CPH independently predicts the risk of post-TIPS HE and mortality. The constructed nomogram exhibits a commendable predictive efficacy for post-TIPS survival.