Clinical application of subjective global assessment in

Chinese patients with gastrointestinal cancer

99/05/20鄒季臻

Word J Gastroenterol 2009July28;15(28):3542-3549

Abstract目的

To investigate the role of subjective global assessment (SGA) in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer.

材料方法 A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study.

Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient.

The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.

Abstract

ANOVA tests revealed significant differences in body mass index (BMI), TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were (P < 0.05).

SGA-A well

nourished

SGA-B mildly to

moderately malnourish

ed

SGA-C severely

malnourished

389 (51.8%)

332 (44.2%)

30 (4.0%)

malnutrition classified

SGA TSF MAMC ALB PA BMI

% 48.2% 39.4% 37.7% 31.3% 21.7% 9.6%

結果

結果χ2 tests showed a significant difference in SGA classification between patients receiving different types of treatment (surgery vs chemotherapy/radiotherapy).

As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly.

Multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery.

The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group (23.3%) and the lowest in the SGA-A group (16.8%).

Abstract

結論 SGA is a reliable assessment tool and helps to predict the ho

spital stay and medical expenditures of Chinese surgical gastrointestinal cancer patients.

Abstract

INTRODUCTION

It is estimated that the number of new cancer patients will reach 15 million in 2020.It was reported about 20% cancer patients die of malnutrition or its relative complications rather than the malignant disease itself.Subjective global assessment (SGA) is an easy, noninvasive, and cost-effective method for the assessment of nutritional status by identifying whether the patients are malnourished or at a risk of becoming malnourished.SGA is a powerful predictor of postoperative complications in general surgery, liver transplantation, and in patients on dialysis. Although SGA has been used widely for more than two decades all over the world, few studies are available on its clinical value in Chinese cancer patients.

MATERIALS AND METHODS

All patients gave their informed consent to participate in this study.Adult patients diagnosed with gastrointestinal cancer (including stomach, colon, or rectal cancer) from August 2004 to August 2006 were enrolled in this study.Eligibility criteria included (a) patients diagnosed by pathology or cytology, (b) patients scheduled to undergo treatment modalities including radiotherapyor chemotherapy or surgery, (c) patients older than 18 years, (d) patients able to read and comprehend Chinese, and (e) patients giving their informed consent.Patients with cognitive impairment, mental disorder, or communication problems were excluded from this study.

MATERIALS AND METHODS

( ),胃癌 人385

結直腸癌( ), 367人

( ),男生 人455

( ),女生 人296

新診斷( ), 591人

舊診斷( ), 160人

The final number of recruited subjects was 751

median age of 69 years (range 23-92 years).

C/TorR/T

505 人 OP;86 人 C/TorR/T

MATERIALS AND METHODS

An initial assessment of nutritional status in all recruited patients was made within 72 h after admission.

If the total number of grade C was more than 5, the nutritional status of patients was classified as severely malnourished.

Based on the results of SGA, patients were assigned to one of the three categories: A (well nourished), B (mildly to moderately malnourished), or C (severely malnourished).

MATERIALS AND METHODS

MATERIALS AND METHODS

Blood samples were collected at anthropometric assessment, before initiation of fluids.Ⅳ

MATERIALS AND METHODS

All patients were followed up until discharge or death.

Complications, including infectious complications (septicemia, incisional, respiratory, abdominal, pelvic, and urinary tract infection) and non-infectious complications (rupture of incision, intestinal obstruction, ascites, cerebrovascular accident, bleeding, and organ failure, etc), were monitored and recorded daily.

Pathological stage of cancer was described by TNM.

RESULTS

malnutrition

classified

SGA TSF MAMC ALB PA BMI

人 362 296 283 230 145 72% 48.2 39.4 37.7 31.3 21.7 9.6Stage Ⅰ Ⅱ Ⅲ Ⅳ

人 142 179 205 225% 18.9 23.8 27.3 30.0

SGA A B C

classified well nourished

mildly to moderatel

y malnouris

hed

severely malnouris

hed

人 389 332 30% 51.8 44.2 4.0

RESULTS

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↓

↓↓↓↓

↓↓

RESULTS

RESULTS

RESULTS

RESULTS

RESULTS

SGA A B C

complications occurrence% 16.8 19.1 23.3

Hospital stay of patients with complications was significantly longer than that of those without complications (26.1 ± 12.1 vs 15.5 ± 7.8, t = -9.67, P = 0.00).

During hospital stay, 8 patients died of various complications (5 in SGA-B group, 2 in SGA-A group,and 1 in SGA-C group). SGA grade was not related with the number of deaths in our study.

The highest prevalence of malnutrition was detected by SGA, the lowest by BMI.our study demonstrated that only a small number of patients were diagnosed with malnutrition by BMI, suggesting that BMI cannot precisely assess malnutrition in Chinese cancer patients.BMI value of 20 should alert clinicians to suspect malnutrition in the elderly.some elderly patients spend most of their day time in bed or totally bedridden, so it is not always easy or sometimes even impossible to measure their weight or height changes.

DISCUSSION

The ALB level alone is not a good representative marker of nutritional status of cancer patients as shown in our study.Our study showed that ALB level was an important factor for prolong hospital stay and medical expenditures of surgical cancer patients.ALB level can be affected by nutritional status and the malignant disease itself, or by inflammatory reactions due to any causes, such as severe liver disease, dehydration, and edema.

DISCUSSION

This study had some limitations. For example, the small sample size in SGA-C group.which may limit the power of data analysis.some patients could not remember their exact body weight and detail dietary intake.quantification of SGA has been advocated as a way to improve the sensitivity and specificity of SGA in diagnosing malnutrition.In conclusion, SGA is a safe, inexpensive and reliable method for assessing nutritional status of Chinese gastrointestinal cancer patients and only can predict their hospital stay and medical expenditures in surgical GI patients.

DISCUSSION

SGA, one of the better available tools, can assess nutritional status, not only because it is patient centered by combining clinical history and physical examination, but also because it is associated with patient outcomes.SGA grade could only predict hospital stay and medical expenditures of surgical cancer patients, but not those of chemotherapy/radiotherapy patients, indicating that type of treatment may influence the predictive value of SGA.Eight patients died of complications during hospital stay. The

reason why only one patient died in the most severely malnourished SGA-C group was due to the small subgroup sample size.

DISCUSSION

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