Impact of GLIM-defined malnutrition on short- and long-term outcomes after emergency gastrointestinal surgery

Malnutrition is a key predictor of adverse outcomes in surgical patients. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized diagnostic framework, evidence regarding their prognostic relevance in emergency gastrointestinal (GI) surgery is limited. This study evaluated whether GLIM-defined malnutrition, including its severity, could predict short- and long-term outcomes after emergency GI surgery.

This retrospective study included 505 adults who underwent emergency GI surgery between 2013 and 2025. Malnutrition was diagnosed according to the GLIM criteria, incorporating weight loss, BMI, and reduced muscle mass as phenotypic criteria. All patients fulfilled the etiologic criterion of inflammation. Postoperative complications and in-hospital mortality served as short-term endpoints, and overall survival (OS) was the long-term endpoint.

GLIM-defined malnutrition was identified in 41.8% of patients, including 26.3% with severe malnutrition. Malnourished patients had higher complication rates (37.9% vs. 22.8%), longer hospital stays (19 vs. 16 days), and higher in-hospital mortality (15.6% vs. 4.8%) (all P < 0.01). In multivariate analyses incorporating severity stratification, severe malnutrition independently predicted postoperative complications and in-hospital mortality, while both moderate and severe malnutrition were independently associated with impaired OS. A stepwise decline in survival was observed, with 1-year OS rates of 90.8% in nonmalnourished patients, 74.5% in moderately malnourished patients, and 65.6% in severely malnourished patients.

GLIM-defined malnutrition severity independently predicted both short- and long-term outcomes after emergency GI surgery. Integrating GLIM-based assessment into perioperative care may facilitate risk stratification and guide targeted nutritional interventions in acutely ill surgical patients.