1
|
Wu J, Cheng X, Yang H, Xiao S, Xu L, Zhang C, Huang W, Jiang C, Wang G. Geriatric nutritional risk index as a prognostic factor in elderly patients with non-muscle-invasive bladder cancer: a propensity score-matched study. Int Urol Nephrol 2024; 56:1627-1637. [PMID: 38177927 DOI: 10.1007/s11255-023-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The Geriatric Nutrition Risk Index (GNRI) is a simple and validated tool used to assess the nutritional status of elderly patients and predict the risk of short-term postoperative complications, as well as the long-term prognosis, after cancer surgery. In this study, we aimed to evaluate the predictive value of GNRI for the long-term postoperative prognosis in elderly patients with primary non-muscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT). METHODS We retrospectively analyzed data from 292 elderly patients with primary NMIBC. Using X-tile software, we divided the cohort into two groups based on GNRI and determined the cut-off value for postoperative recurrence-free survival (RFS). Propensity score matching (PSM) with a ratio of 1:3, Kaplan-Meier analysis, log-rank test, and COX proportional hazards regression were used to assess the correlation between GNRI and prognosis and identify factors predicting recurrence and progression. RESULTS In the entire cohort, the 3 year recurrence group had significantly lower GNRI compared to the 3 year non-recurrence group (P = 0.0109). The determined GNRI cut-off value was 93.82. After PSM, the low GNRI group had significantly lower RFS (P < 0.0001) and progression-free survival (PFS) (P = 0.0040) than the high GNRI group. Multivariate COX regression showed that GNRI independently predicted RFS (HR 2.108; 95% CI 1.266-3.512; P = 0.004) and PFS (HR 2.155; 95% CI 1.135-4.091; P = 0.019) in elderly patients with primary NMIBC. CONCLUSION Preoperative GNRI is a prognostic marker for disease recurrence and progression in elderly patients with primary NMIBC undergoing TURBT.
Collapse
Affiliation(s)
- Jingxin Wu
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Heng Yang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Song Xiao
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Linhao Xu
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Cheng Zhang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Wei Huang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Chunwen Jiang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Gongxian Wang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China.
| |
Collapse
|
2
|
Yu W, Wang H, Li M, Yang F, Bai J, Song H, Huang X. Prognostic value of geriatric nutritional risk index in patients with amyotrophic lateral sclerosis. J Clin Neurosci 2024; 122:19-24. [PMID: 38432041 DOI: 10.1016/j.jocn.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/13/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The geriatric nutritional risk index (GNRI) is a prognostic indicator for several diseases, meanwhile, nutrition and inflammation play important roles in the disease progression of amyotrophic lateral sclerosis (ALS). However, the association between the GNRI and ALS remains unknown. METHODS 443 patients diagnosed with ALS were divided into two groups based on the GNRI levels. Associations between GNRI and survival time were analyzed using Kaplan-Meier curves and compared by the log-rank test. Univariate and multivariate analyses were used to assess their prognostic values for survival time. Spearman correlation analysis was used to evaluate the correlation coefficients between GNRI and other clinical variables. RESULTS No significant differences were found in diagnostic delay between the two groups. The onset age and disease progression rate (DPR) were significantly lower in high GNRI group while forced vital capacity (FVC), revised version of the ALS functional rating scale (ALSFRS-R), serum albumin and body mass index (BMI) were significantly lower in low GNRI group. Lower GNRI levels were linked with shorter ALS patients' survival time by Kaplan-Meier curves. The univariate and multivariate analysis identified the onset age, gender, onset site, diagnostic delay, DRP and GNRI as predictors of survival time in patients with ALS. CONCLUSION Nutritional status was closely corelated with ALS progression. The GNRI may be used as a potential prognostic indictor for ALS patients.
Collapse
Affiliation(s)
- Wenxiu Yu
- Medical School of Chinese PLA, Beijing 100853, China; Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Hongfen Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Mao Li
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fei Yang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiongming Bai
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; College of Medicine, Nankai University, Tianjin 300071, China
| | - Han Song
- Department of Health Service, Chinese PLA General Hospital, Beijing 100853, China.
| | - Xusheng Huang
- Medical School of Chinese PLA, Beijing 100853, China; Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
3
|
Sun S, Tao S, Xi X, Jiang T, Zhu Q, Zhou Y, Li H. Analysis of the predictive value of the Geriatric Nutritional Risk Index for osteoporosis in elderly patients with T2DM: a single-center retrospective study. J Orthop Surg Res 2023; 18:760. [PMID: 37805606 PMCID: PMC10560427 DOI: 10.1186/s13018-023-04237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Malnutrition is recognized as a risk factor for osteoporosis and T2DM. Previous studies have demonstrated the relationship between nutritional assessment tools and BMD. However, few studies have compared the effects of three nutritional risk assessment tools (GNRI, CONUT, and PNI). This study aimed to investigate the correlation between three nutritional assessment tools and BMD and to compare their validity in predicting osteoporosis in type 2 diabetes mellitus in the elderly. METHODS This retrospective study collected clinical data from 525 elderly patients with type 2 diabetes mellitus and categorized the patients into osteoporotic and non-osteoporotic groups. The correlation between the three nutritional assessment tools and BMD was analyzed using Spearman partial correlation. Binary logistics regression was used to analyze the relationship between GNRI and osteoporosis. ROC curves were used to compare the validity of GNRI, PNI, and CONUT in predicting osteoporosis. RESULTS Spearman's partial correlation showed a positive correlation between femoral neck BMD and lumbar spine BMD, but no correlation was observed between total hip BMD and GNRI. Logistic regression analyses showed no association between PNI, CONUT scores, and the development of osteoporosis. After adjusting for age, sex, smoking, alcohol consumption, BMI, ALB, Cr, UA, FBG, TG, and HDL, the correlation between GNRI and osteoporosis remained. ROC curve analysis showed that GNRI in combination with age and albumin had better predictive ability for osteoporosis than PNI and CONUT. CONCLUSION GNRI was an independent protective factor against osteoporosis in elderly patients with T2DM, and the predictive ability of GNRI for osteoporosis in elderly patients with T2DM was better than that of PNI and CONUT scores.
Collapse
Affiliation(s)
- Silu Sun
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Simin Tao
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Xiaoyan Xi
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Avenue, Middle Section, Chengdu, 610599, China
| | - Tao Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Avenue, Middle Section, Chengdu, 610599, China
| | - Qian Zhu
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Yan Zhou
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Hui Li
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China.
| |
Collapse
|
4
|
Mochizuka Y, Suzuki Y, Kono M, Hasegawa H, Hashimoto D, Yokomura K, Inoue Y, Yasui H, Hozumi H, Karayama M, Furuhashi K, Enomoto N, Fujisawa T, Inui N, Nakamura H, Suda T. Geriatric Nutritional Risk Index is a predictor of tolerability of antifibrotic therapy and mortality risk in patients with idiopathic pulmonary fibrosis. Respirology 2023. [PMID: 37221050 DOI: 10.1111/resp.14523] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/22/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic pulmonary fibrosis (IPF) is characterized by progressive lung fibrosis of unknown aetiology. Epidemiological studies have suggested that IPF progression may negatively affect nutritional status. Weight loss during antifibrotic therapy is also frequently encountered. The association of nutritional status and outcome has not been fully evaluated in IPF patients. METHODS This retrospective multicohort study assessed nutritional status of 301 IPF patients receiving antifibrotic therapy (Hamamatsu cohort, n = 151; Seirei cohort, n = 150). Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). The GNRI was calculated based on body mass index and serum albumin. The relationship between nutritional status and tolerability of antifibrotic therapy as well as mortality was explored. RESULTS Of 301 patients, 113 (37.5%) had malnutrition-related risk (GNRI < 98). Patients with malnutrition-related risk were older, had increased exacerbations and worse pulmonary function than those without a GNRI status <98. Malnutrition-related risk was associated with a higher incidence of discontinuation of antifibrotic therapy, particulary due to gastrointestinal disturbances. IPF patients with malnutrition-related risk (GNRI < 98) had shorter survival than those without such risk (median survival: 25.9 vs. 41.1 months, p < 0.001). In multivariate analysis, malnutrition-related risk was a prognostic indicator of antifibrotic therapy discontinuation and mortality, independent of age, sex, forced vital capacity, or gender-age-physiology index. CONCLUSION Nutritional status has significant effects on the treatment and outcome in patients with IPF. Assessment of nutritional status may provide important information for managing patients with IPF.
Collapse
Affiliation(s)
- Yasutaka Mochizuka
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hirotsugu Hasegawa
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yusuke Inoue
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
5
|
Lee ZY, Loh CTI, Lew CCH, Ke L, Heyland DK, Hasan MS. Nutrition therapy in the older critically ill patients: A scoping review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2022160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population.
Method: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied.
Results: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia.
Conclusion: Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
Keywords: Critical care nutrition, geriatric patients, intensive care medicine, older adults, scoping review
Collapse
Affiliation(s)
| | | | | | - Lu Ke
- Medical School of Nanjing, Nanjing, China
| | | | | |
Collapse
|
6
|
Funahashi H, Morita D, Iwase T, Asamoto T. Usefulness of nutritional assessment using Geriatric Nutritional Risk Index as an independent predictor of 30-day mortality after hip fracture surgery. Orthop Traumatol Surg Res 2022; 108:103327. [PMID: 35577274 DOI: 10.1016/j.otsr.2022.103327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Geriatric Nutritional Risk Index (GNRI) is an objective nutritional status assessment tool used for predicting mortality risk in hospitalized patients. However, it is unclear whether GNRI reflects short-term mortality for hip fracture patients after surgery. We examined the usefulness of the nutritional status assessed by the GNRI and identified cutoff scores that predict mortality risk. Does GNRI on admission predict the mortality after surgery for hip fracture? HYPOTHESIS Evaluation of GNRI could help identify patients at higher risk of 30-day mortality after hip fracture surgery. MATERIALS AND METHODS This retrospective study used data from 1040 patients who underwent hip fracture surgery. Fatalities within 30 days after hip fracture surgery were investigated. The GNRI was calculated on admission in all patients as follows: 14.89×serum albumin (g/dL)+41.7×body mass index/22. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) and the optimal cutoff score that could predict 30-day mortality after hip fracture surgery. This cutoff score was used for comparing the mortality rates between patient groups with a GNRI higher and lower than the cutoff score using Fisher's exact test. Logistic regression analysis was used to determine risk factors of 30-day mortality. RESULTS There were 17 fatalities (1.6%) in the cohort. The ROC-AUC value was 0.811, and the cutoff GNRI was 75.4. Mortality was significantly higher in the group with a GNRI<75.4 compared with the group with a GNRI≥75.4 (odds ratio [OR], 22.99; 95% confidence interval [95% CI], 7.55-78.05; p=0.00000004). A GNRI<75.4 was a significant predictor of mortality within 30-days after hip fracture surgery (OR, 27.1; 95% CI, 8.57-85.9; p≤0.0001). DISCUSSION Our results show that nutritional status assessment using GNRI can help predict 30-day mortality among geriatric patients undergoing surgery for hip fracture. The GNRI is a simple and accurate tool for predicting the risk of mortality after hip fracture surgery. LEVEL OF EVIDENCE IV; case series study.
Collapse
Affiliation(s)
- Hiroto Funahashi
- Hamamatsu Medical Center, Hamamatsu, Iryo Center, 328 Tomitsuka-Cho, Naka-Ku, 4328580 Hamamatsu, Shizuoka, Japan
| | - Daigo Morita
- Hamamatsu Medical Center, Hamamatsu, Iryo Center, 328 Tomitsuka-Cho, Naka-Ku, 4328580 Hamamatsu, Shizuoka, Japan.
| | - Toshiki Iwase
- Hamamatsu Medical Center, Hamamatsu, Iryo Center, 328 Tomitsuka-Cho, Naka-Ku, 4328580 Hamamatsu, Shizuoka, Japan
| | - Takamune Asamoto
- Hamamatsu Medical Center, Hamamatsu, Iryo Center, 328 Tomitsuka-Cho, Naka-Ku, 4328580 Hamamatsu, Shizuoka, Japan
| |
Collapse
|
7
|
Mao Z, Wen T, Liu X, Chen J, Hu P, Liu C, Liu H, Kang H, Zhang Z, Zhou F. Geriatric Nutritional Risk Index is Associated with Hospital Death in Elderly Patients with Multiple Organ Dysfunction Syndrome: A Retrospective Study Based on the MIMIC-III Database. Front Nutr 2022; 9:834256. [PMID: 35719142 PMCID: PMC9204224 DOI: 10.3389/fnut.2022.834256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Elderly patients with multiple organ dysfunction syndrome (MODS) have a higher mortality during hospitalization in the intensive care unit (ICU). Elderly patients often suffer from malnutrition. On the basis of the MIMIC-III database, this study analyzed the effect of the baseline nutritional status on the death of elderly patients with MODS during hospitalization. Materials and Methods Elderly patients with MODS were screened out from MIMIC-III 1.4 database. The geriatric nutritional risk index (GNRI) was calculated and used to group patients into: normal nutrition (GNRI > 98) and malnutrition (GNRI ≤ 98) groups. The malnutrition group was divided into mild (92–98), moderate (82–91), and severe (≤81) groups. The differences in the baseline data and the incidence of adverse events between groups were compared. The GAM model was used to determine whether a curve relationship was present between the hospital death of elderly patients with MODS and GNRI and analyze the threshold saturation effect. The multivariate logistic regression was used to calculate the odds ratio (OR) of in-hospital deaths in different GNRI groups. The interaction test was performed to find subgroups with differences. Results A total of 2456 elderly patients with MODS were enrolled. A total of 1,273 (51.8%) and 1183 (48.2%) patients were in the normal nutrition and malnutrition groups, respectively. The mortality rate of patients in the normal nutrition group during hospitalization was lower than that in the malnutrition group (206/1273 vs. 292/1183, X2 = 27.410, P < 0.001; OR = 0.59, 95% CI: 0.48–0.72). The GAM model fitting analysis showed a threshold saturation effect at GNRI = 92. Adjusted OR values with GNRI ≥ 92 began to change to 1, and GNRI and death had no association. At GNRI < 92, high GNRI related to low risk of death. Subgroup analysis of patients with GNRI < 92 showed that the risk of death in elderly male patients was lower than that of female patients. Conclusion GNRI is related to the severity of illness in elderly patients with MODS. At GNRI < 92, moderate to severe malnutrition increases the risk of death in elderly patients with MODS during hospitalization.
Collapse
Affiliation(s)
- Zhi Mao
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tao Wen
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoli Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jinsong Chen
- Department of Gerentology, Zhangzhou Zhengxing Geriatrics Hospital, Zhangzhou, China
| | - Pan Hu
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chao Liu
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Liu
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongjun Kang
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhengbo Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Center for Artificial Intelligence in Medicine, Chinese Peoples Liberation Army General Hospital, Beijing, China
- Department of Biomedical Engineering, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- *Correspondence: Feihu Zhou
| |
Collapse
|
8
|
Liu H, Jiao J, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Sun X, Wu X, Xu T. Nutritional Status According to the Short-Form Mini Nutritional Assessment (MNA-SF) and Clinical Characteristics as Predictors of Length of Stay, Mortality, and Readmissions Among Older Inpatients in China: A National Study. Front Nutr 2022; 9:815578. [PMID: 35145987 PMCID: PMC8822231 DOI: 10.3389/fnut.2022.815578] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background Studies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes. Methods This prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization. Results We found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0–7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8–11 (OR 3.283, 95% CI 2.126–5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12–14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0–7 (regression coefficient 0.2807, 95% CI 0.0294–0.5320; P < 0.05) and a score of 8–11 (0.2574, 95% CI 0.0863–0.4285; P < 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12–14. MNA-SF scores 0–7 (OR 1.393, 95% CI 1.052–1.843) and 8–11 (OR 1.356, 95% CI 1.124–1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12–14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24–27.9 kg/m2, age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population. Conclusions Malnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.
Collapse
Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences—Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences—Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
- *Correspondence: Jing Jiao
| | - Minglei Zhu
- Department of Geriatrics, Chinese Academy of Medical Sciences—Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Haerbin Medical University, Haerbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xiang Sun
- Department of Nursing, Chinese Academy of Medical Sciences—Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences—Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
- Xinjuan Wu
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
- Tao Xu
| |
Collapse
|
9
|
Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy. Nutrients 2021; 13:nu13093176. [PMID: 34579053 PMCID: PMC8465593 DOI: 10.3390/nu13093176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07-0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.
Collapse
|