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. 2025 Aug 15;25(1):586.
doi: 10.1186/s12876-025-04160-y.

A GLIM-defined malnutrition-based model for predicting prognosis of cirrhotic patients with portal hypertension following TIPS procedure

Wen-Ting Huang  1 , De-Lei Cheng  1 , Liang Yin  1 , Li Dong  1 , Yi-Jiang Zhu  1 , Liu Zhang  1 , Dong Lu  1 , Chun-Ze Zhou  1 , Wei-Fu Lv  2
Affiliations

A GLIM-defined malnutrition-based model for predicting prognosis of cirrhotic patients with portal hypertension following TIPS procedure

Wen-Ting Huang et al. BMC Gastroenterol. .

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 post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) occurrence and mortality 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 = 0.003) and diminished overall survival (OS) rates (p < 0.0001). Malnutrition based on GLIM criteria was the independent predictor for HE and post-TIPS survival (HR = 1.64, 95%CI: 1.27–2.13, p < 0.001 and HR = 2.13, 95%CI: 1.53–2.96, p < 0.001, 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.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12876-025-04160-y.

Keywords: Cirrhotic portal hypertension; GLIM criteria; Hepatic encephalopathy; Malnutrition; Survival; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted with strict adherence to the Declaration of Helsinki. This study was approved by the Ethics Review Committee of the First Affiliated Hospital of the University of Science and Technology of China(approval number: 2023-RE-283). The need for informed consent was waived by the Ethics Review Committee due to the retrospective nature of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection
Fig. 2
Fig. 2
Cumulative incidence functions for incidence of post-TIPS HE and Kaplan–Meier curves for overall survival: (A) overt HE in all patients, (B) severe HE in all patients, (C) cumulative survival in all patients (D) overt HE in three groups of patients: normal nutrition, moderate malnutrition, and severe malnutrition, (E) severe HE in three groups of patients and (F) cumulative survival in three groups of patients
Fig. 3
Fig. 3
A nomogram for prediction of post-TIPS survival (A). Forest plot-based multivariable Cox regression models for overall survival (B). ROC curve of the nomogram predicting post-TIPS survival in training set (C) and validation set (D). Calibration curve of the nomogram predicting post-TIPS survival in training set (E) and validation set (F)
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