Dataset Information

Malnutrition in patients with chronic GVHD.

ABSTRACT: Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.

SUBMITTER: Bassim CW

PROVIDER: S-EPMC5535789 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Malnutrition in patients with chronic GVHD.

Bassim C W CW Fassil H H Dobbin M M Steinberg S M SM Baird K K Cole K K Joe G G Comis L E LE Mitchell S A SA Grkovic L L Edwards D D Mays J W JW Cowen E W EW Pulanic D D Williams K M KM Gress R E RE Pavletic S Z SZ

Bone marrow transplantation 20140714 10

Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had lo ...[more]

PMID: 25029231

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Project description:BackgroundMalnutrition is common in patients with chronic heart failure (CHF) and is associated with adverse outcome, but few data exist.ObjectivesThe objective of this study was to compare the agreement and classification performance of 6 malnutrition tools in patients with CHF.MethodsWe evaluated the performance of 6 malnutrition tools: COntrolling NUTritional Status Index (CONUT), Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment-Short Form (MNA-SF), and Subjective Global Assessment (SGA), in 467 consecutive patients with CHF who attended our clinic for follow-up. We used Venn diagrams and Kappa statistics to study the agreement of different tools. Because there is no "gold standard" for malnutrition evaluation, for each of the malnutrition tools, we used the results of the other 5 tools to produce a standard combined index for evaluating at least moderate malnutrition. Subjects were considered as having at least moderate malnutrition if so identified by ?3/5 tools. We evaluated the sensitivity, specificity, and predictive values of different tools in identifying significant malnutrition as defined by the combined index.ResultsMen comprised 67% of patients, median age was 76 years, and median N-terminal pro-B-type natriuretic peptide (NTproBNP) was 1156 ng/L. The prevalence of any degree and at least moderate malnutrition ranged between 6-60% and 3-9%, respectively, with CONUT classifying the highest proportion of subjects as malnourished. Malnourished patients tended to be older and have worse symptoms, higher NTproBNP, and more comorbidities. CONUT had the highest sensitivity (80%), MNA-SF and SGA had the highest specificity (99%), and MNA-SF had the lowest misclassification rate (2%) in identifying at least moderate malnutrition as defined by the combined index.ConclusionsMalnutrition is common in patients with CHF. The prevalence of malnutrition varies depending on the tool used. Among the 6 malnutrition tools studied, MNA-SF has the best classification performance in identifying significant malnutrition as defined by the combined index.

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Malnutrition in patients with chronic GVHD.

Publications

Malnutrition in patients with chronic GVHD.

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