Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention

Association Between the Malnutrition Status and All-Cause Mortality in Patients With Moderate and Severe Aortic Stenosis: A Prospective Cohort Study

BACKGROUND

Malnutrition status is an important predictor of prognosis in patients after aortic valve replacement. However, the prognostic value of malnutrition status in patients with moderate-to-severe aortic stenosis is unclear. This study aimed to evaluate the effect of malnutrition on all-cause mortality in patients with moderate-to-severe aortic stenosis using the Patient Controlled Nutritional Status (CONUT) score, nutritional risk index, and prognostic nutritional index.

METHODS AND RESULTS

A total of 536 patients with moderate-to-severe aortic stenosis were selected in the ARISTOTLE (Aortic Valve Diseases Risk Factor Assessment and Prognosis Model Construction) study conducted between January 2013 and December 2022 in 3 academic institutions. Patients were grouped according to different nutritional status assessment methods. CONUT, nutritional risk index, and prognostic nutritional index were calculated at baseline. The primary study outcome was all-cause mortality. Cox regression was used to assess the association between nutritional status and all-cause mortality. During a median 34.2-month follow-up period, a total of 120 (22.4%) patients died. All-cause mortality was significantly higher in lower prognostic nutritional index, lower nutritional risk index, and higher CONUT groups. Compared with normal nutrition, malnutrition was associated with an increased risk for all-cause death (adjusted hazard ratio for mild and moderate-severe malnutrition, respectively: 2.82 [95% CI, 1.69-4.71; P<0.001] and 3.31 [95% CI, 1.74-6.32; P<0.001] for the CONUT).

CONCLUSIONS

In patients with moderate or severe aortic stenosis, we found that high CONUT scores, low nutritional risk index scores, and low prognostic nutritional index scores were associated with all-cause death. The poorer the nutritional status, the greater the risk of malnutrition-related all-cause mortality.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT06069232.

Geriatric nutritional risk index as a predictor for surgical site infection in malignant musculoskeletal tumours of the trunk

BACKGROUND AND OBJECTIVE

Surgical site infection (SSI) is common in surgery for malignant musculoskeletal tumours, specifically those arising from the trunk. In this study, we investigated the risk factors for SSI after resection of musculoskeletal tumours of the trunk.

METHODS

This retrospective observational study included 125 patients (72 males, 53 females) with musculoskeletal tumours of the trunk in our hospital from 1 April 2008 to 31 August 2023. The incidence of SSI and its risk factors were investigated.

RESULTS

SSI was observed in 26% (32/125), and the median time to SSI was 22 days. On multivariate analysis, the following were identified as risk factors for SSI: tumours arising caudal to Jacoby's line (hazard ratio [HR] 4.04; P = .0107), soft tissue reconstruction (HR 3.43; P = .0131), and low Geriatric Nutritional Risk Index (GNRI) (HR 0.96; P = .0304). Patients were classified into two risk categories based on GNRI scores: the risk group (GNRI ≤98) and no risk group (>98). The risk group showed a significantly lower overall noninfection survival rate (P = .023).

CONCLUSION

Tumours arising caudal to Jacoby line, soft tissue reconstruction, and lower GNRI were risk factors for SSI. Preoperative and postoperative nutritional interventions should be considered to improve GNRI.

Percutaneous coronary intervention for unprotected left main distal bifurcation lesions in elderly people

BACKGROUND

In the elderly people with unprotected left main distal bifurcation lesions (ULMD), percutaneous coronary intervention (PCI) is often selected as first choice treatment strategy because of perioperative high risk of coronary artery bypass graft surgery due to their large number of comorbidities. Also, some recent papers reported that geriatric nutritional risk index (GNRI) is also strongly associated with clinical outcomes after interventional procedures in elderly patients.

OBJECTIVES

We assessed clinical outcomes after PCI for ULMD and the impact of GNRI in elderly patients.

METHODS

We identified 669 non dialysis patients treated with current generation drug-eluting stent for ULMD from MITO registry. We divided the patients to the following 2 groups; elderly group (n = 240, age ≥75) and young group (n = 429, age <75). Additionally, we could calculate GNRI and divided elderly group into 2 group based on the median value of the GNRI. The primary endpoint was all-cause mortality.

RESULTS

All-cause mortality was significantly higher in elderly group [adjusted hazard ratio (HR) 2.37; 95% confidence interval (CI), 1.40-4.02; p = 0.001]. All-cause mortality was significantly higher in low GNRI elderly group compared to other 2 groups (Adjusted HR of elderly with low GNRI: 3.56, 95%CI (1.77-7.14), p < 0.001). Cardiovascular mortality was comparable between two groups. TLR rate was significantly lower in elderly group (adjusted HR 0.57; 95% CI, 0.34-0.97; p = 0.035).

CONCLUSIONS

The elderly had higher all-cause mortality after PCI for ULMD compared to young people. Especially, the elderly with low GNRI were extremely associated with poorer outcomes.

Prognostic impact of malnutrition in patients with coronary artery disease: a systematic review and meta-analysis

CONTEXT

Conflicting predictions of malnutrition for the long-term prognosis of coronary artery disease (CAD) exist.

OBJECTIVE

This study aimed to investigate the relationship between malnutrition and long-term prognosis of patients with CAD.

DATA SOURCES

Four databases were searched for articles from February 11, 1936, to September 10, 2022.

DATA EXTRACTION

Cohort studies adjusting for multiple cardiovascular risk factors with data on CAD and malnutrition were included. Malnutrition was measured and defined by different nutritional evaluation tools. The hazard ratios (HRs) and confidence intervals (CIs) for all-cause mortality and major adverse cardiovascular events (MACEs) were synthesized. Subgroup analyses were performed based on study design, assessment tools, ethnicity/race, follow-up, sample size, and types of CAD. Meta-regression was used to compare whether the effect sizes of the 2 subgroups were statistically significant.

DATA ANALYSIS

A total of 30 cohort studies were included, totaling 81 361 participants with CAD. Nutritional evaluation tools, including the Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), Nutritional Risk Screening 2002, Mini-Nutritional Assessment, and Prognostic Nutritional Index, were used. Malnutrition increased all-cause mortality (HR = 1.72; 95% CI: 1.53, 1.93) and MACEs (HR = 1.47; 95% CI: 1.35, 1.60) in patients with CAD. Subgroup analysis revealed the results were consistent across study design, ethnicity/race, follow-up, sample size, and types of CAD. Subgroup analyses and meta-regression revealed that malnutrition was associated with a higher risk of all-cause mortality (HR = 2.26; 95% CI: 1.91, 2.68) and MACEs (HR = 2.28; 95% CI: 1.69, 3.08) in patients with stable CAD than those with other types of CAD. Meta-regression revealed that the GNRI (HR = 2.20; 95% CI: 1.65, 2.93) was more effective than CONUT (HR = 1.47; 95% CI: 1.21, 1.78) in predicting all-cause mortality.

CONCLUSION

Malnutrition independently increased all-cause mortality by 72% and MACEs by 47% in patients with CAD, especially with stable CAD. The GNRI is a more effective nutritional evaluation tool than CONUT in predicting all-cause mortality.

Prognostic value of geriatric nutritional risk index in patients with stable coronary artery disease undergoing percutaneous coronary intervention

BACKGROUND

Malnutrition increases the risk of poor prognosis in patients with cardiovascular disease, and our current research was designed to assess the predictive performance of the Geriatric Nutrition Risk Index (GNRI) for the occurrence of poor prognosis after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (SCAD) and to explore possible thresholds for nutritional intervention.

METHODS

This study retrospectively enrolled newly diagnosed SCAD patients treated with elective PCI from 2014 to 2017 at Shinonoi General Hospital, with all-cause death as the main follow-up endpoint. Cox regression analysis and restricted cubic spline (RCS) regression analysis were used to explore the association of GNRI with all-cause death risk and its shape. Receiver operating characteristic curve (ROC) analysis and piecewise linear regression analysis were used to evaluate the predictive performance of GNRI level at admission on all-cause death in SCAD patients after PCI and to explore possible nutritional intervention threshold points.

RESULTS

The incidence of all-cause death was 40.47/1000 person-years after a mean follow-up of 2.18 years for 204 subjects. Kaplan-Meier curves revealed that subjects at risk of malnutrition had a higher all-cause death risk. In multivariate Cox regression analysis, each unit increase in GNRI reduced the all-cause death risk by 14% (HR 0.86, 95% CI 0.77, 0.95), and subjects in the GNRI > 98 group had a significantly lower risk of death compared to those in the GNRI < 98 group (HR 0.04, 95% CI 0.00, 0.89). ROC analysis showed that the baseline GNRI had a very high predictive performance for all-cause death (AUC = 0.8844), and the predictive threshold was 98.62; additionally, in the RCS regression analysis and piecewise linear regression analysis we found that the threshold point for the GNRI-related all-cause death risk was 98.28 and the risk will be significantly reduced when the subjects' baseline GNRI was greater than 98.28.

CONCLUSIONS

GNRI level at admission was an independent predictor of all-cause death in SCAD patients after PCI, and GNRI equal to 98.28 may be a useful threshold for nutritional intervention in SCAD patients treated with PCI.

Geriatric Nutritional Risk Index predicts bleeding event in patients with heart failure

AIMS

We aimed to elucidate the association between malnutrition and the occurrence of bleeding events in patients with heart failure.

METHODS AND RESULTS

We evaluated the nutritional status of patients with heart failure [n = 2044, median (inter-quartile range) age 69.0 (59.0-78.0) years, 1209 (59.1%) males] using the Geriatric Nutritional Risk Index (GNRI). The primary endpoint was a composite of bleeding events such as haemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut-off point of GNRI for predicting the primary endpoint was 106.2. We divided the patients into two groups based on GNRI levels: high GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and low GNRI group (GNRI < 106.2, n = 1438, 70.4%). We compared the patients' characteristics and prognosis between the two groups. The low GNRI group was older [72.0 (63.0-79.0) vs. 63.0 (53.0-73.0) years, P < 0.001] and had a lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001). There were no differences in the use of antiplatelet agents and anticoagulants between the two groups. Levels of B-type natriuretic peptide were higher [321.1 (123.3-667.4) vs. 111.6 (42.6-235.4) pg/mL, P < 0.001] and levels of haemoglobin were lower [12.4 (10.8-13.7) vs. 14.2 (12.9-15.4) g/dL, P < 0.001] in the low GNRI group. The Kaplan-Meier analysis demonstrated that bleeding event rates were higher in the low GNRI group (log-rank P < 0.001). The multivariable Cox proportional hazard analysis revealed that low GNRI (hazard ratio 1.952, 95% confidence interval 1.002-3.805, P = 0.049) was associated with bleeding events.

CONCLUSIONS

Heart failure patients with poor nutritional status, determined by GNRI under 106.2, experienced high bleeding event rates. Comprehensive management is required to avoid bleeding event in those populations.

Low geriatric nutritional risk index as a poor prognostic biomarker for immune checkpoint inhibitor treatment in solid cancer

Objective

In this investigation, we focused on the geriatric nutritional risk index (GNRI), a comprehensive metric that takes into account the patient's ideal weight, actual weight, and serum albumin levels to measure malnutrition. Our primary objective was to examine the predictive value of GNRI-defined malnutrition in determining the response to immunotherapy among cancer patients.

Methods

Relevant articles for this study were systematically searched in PubMed, the Cochrane Library, EMBASE, and Google Scholar up to July 2023. Our analysis evaluated overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) as clinical outcomes.

Results

This analysis comprised a total of eleven articles encompassing 1,417 patients. The pooled results revealed that cancer patients with low GNRI levels exhibited shorter OS (HR: 2.64, 95% CI: 2.08-3.36, p < 0.001) and PFS (HR: 1.87, 95% CI: 1.46-2.41, p < 0.001), and lower ORR (OR: 0.46, 95% CI: 0.33-0.65, p < 0.001) and DCR (OR: 0.42, 95% CI: 0.29-0.61, p < 0.001). Sensitivity analyses confirmed that the above results were stable. Egger's and Begg's tests revealed that there was no publication bias in the above results.

Conclusion

Our results imply that the GNRI is a useful predictor of immunotherapy response in cancer patients.

The clinical predictive value of geriatric nutritional risk index in elderly rectal cancer patients received surgical treatment after neoadjuvant therapy

Objective

The assessment of nutritional status has been recognized as crucial in the treatment of geriatric cancer patients. The objective of this study is to determine the clinical predictive value of the geriatric nutritional risk index (GNRI) in predicting the short-term and long-term prognosis of elderly rectal cancer (RC) patients who undergo surgical treatment after neoadjuvant therapy.

Methods

Between January 2014 and December 2020, the clinical materials of 639 RC patients aged ≥70 years who underwent surgical treatment after neoadjuvant therapy were retrospectively analysed. Propensity score matching was performed to adjust for baseline potential confounders. Logistic regression analysis and competing risk analysis were conducted to evaluate the correlation between the GNRI and the risk of postoperative major complications and cumulative incidence of cancer-specific survival (CSS). Nomograms were then constructed for postoperative major complications and CSS. Additionally, 203 elderly RC patients were enrolled between January 2021 and December 2022 as an external validation cohort.

Results

Multivariate logistic regression analysis showed that GNRI [odds ratio = 1.903, 95% confidence intervals (CI): 1.120-3.233, p = 0.017] was an independent risk factor for postoperative major complications. In competing risk analysis, the GNRI was also identified as an independent prognostic factor for CSS (subdistribution hazard ratio = 3.90, 95% CI: 2.46-6.19, p < 0.001). The postoperative major complication nomogram showed excellent performance internally and externally in the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analysis (DCA). When compared with other models, the competing risk prognosis nomogram incorporating the GNRI achieved the highest outcomes in terms of the C-index, AUC, calibration plots, and DCA.

Conclusion

The GNRI is a simple and effective tool for predicting the risk of postoperative major complications and the long-term prognosis of elderly RC patients who undergo surgical treatment after neoadjuvant therapy.

Geriatric nutritional risk index was associated with in-hospital mortality among cardiac intensive care unit patients

Background

Identifying risk factors associated with cardiac intensive care unit (CICU) patients' prognosis can help clinicians intervene earlier and thus improve their prognosis. The correlation between the geriatric nutrition risk index (GNRI), which reflects nutritional status, and in-hospital mortality among CICU patients has yet to be established.

Method

The present study retrospectively enrolled 4,698 CICU patients. Based on the nutritional status, the participants were categorized into four groups. The primary endpoint was in-hospital mortality. The length of hospital stay and length of CICU stay were the secondary endpoints. To explore the correlation between nutritional status and in-hospital mortality, a logistic regression analysis was conducted. The nonlinear associations of GNRI with in-hospital mortality were evaluated using restricted cubic spline (RCS). Furthermore, subgroup analyses were conducted to evaluate the effect of the GNRI on in-hospital mortality across different subgroups, with calculation of the p for interaction.

Result

A higher risk of malnutrition was significantly linked to an increased incidence of in-hospital mortality (High risk vs. No risk: 26.2% vs. 4.6%, p < 0.001), as well as a longer length of hospital stay (High risk vs. No risk: 15.7, 9.1-25.1 vs. 8.9, 6.9-12.9, p < 0.001) and CICU stay (High risk vs. No risk: 6.4, 3.8-11.9 vs. 3.2, 2.3-5.1, p < 0.001). An elevated GNRI was significantly associated with an increased risk of in-hospital mortality even after controlling for pertinent confounding factors (High risk vs. No risk: OR, 95% CI: 2.37, 1.67-3.37, p < 0.001, p for trend <0.001). Additionally, the RCS model showed a linear relationship between GNRI and in-hospital mortality, with the risk of in-hospital mortality significantly decreasing as GNRI increased (non-linear p = 0.596). Furthermore, in the subgroups of hypertension, ventricular arrhythmias, cardiac arrest, shock, and chronic kidney disease, there was a significant interaction between nutritional status and in-hospital mortality.

Conclusion

Among CICU patients, a low GNRI was a significant predictor of in-hospital mortality. Furthermore, patients with a higher risk of malnutrition, as indicated by low GNRI values, experienced significantly longer hospital and CICU stays.

Prognostic Utility of Nutritional Risk Index in Patients with Head and Neck Soft Tissue Sarcoma

BACKGROUND

The nutritional risk index (NRI) is an excellent indicator of nutritional status and a significant prognostic factor in several malignancies, but the relationship between NRI and the prognosis of head and neck soft tissue sarcoma (HNSTS) patients remains unclear. The aim of this study was to investigate the role of NRI in patients with HNSTS.

METHODS

We retrospectively reviewed patients with HNSTS between 1990 and 2021. In order to determine the optimal cut-off value of NRI, the Maximally selected log-rank statistic was performed. We evaluated the effect of NRI on overall survival (OS) and progression-free survival (PFS) by using the Kaplan-Meier method and Cox regression analysis. Then, OS and PFS nomograms based on NRI were constructed.

RESULTS

In total, 436 HNSTS patients were included in this study. The optimal cut-off value of NRI was 99.34. Patients with low-NRI showed significantly worse OS and PFS than patients with high-NRI, respectively (5-year OS rate of 43.0 vs. 70.8%, 5-year PFS rate of 29.0 vs. 45.0%, all p < 0.05). In the multivariate analysis, distant metastasis, deep tumor depth, tumor grade, and NRI were prognostic factors for both PFS and OS, and treatment modality was associated with OS but not PFS. The concordance indexes (C-indexes) of OS and PFS nomograms were 0.794 (95% CI, 0.759-0.829) and 0.663 (95% CI, 0.626-0.700), respectively, which also performed well in the validation set.

CONCLUSIONS

NRI is an independent predictor of OS and PFS in HNSTS patients. The validated nomograms based on NRI provide useful predictions of OS and PFS for patients with HNSTS.

Association of a novel nutritional index with stroke in Chinese population with hypertension: Insight from the China H-type hypertension registry study

Objective

The abbreviated TCB index (TCBI) is a novel indicator of nutritional status, calculated by multiplying the serum values of triglycerides (TG), total serum cholesterol (TC), and body weight. The research on the relationship between this index and stroke is limited. We aimed to investigate the association between TCBI and stroke in Chinese hypertensive patients.

Methods and results

A total of 13,358 adults with hypertension from the China H-type Hypertension Registry Study were enrolled. The TCBI was calculated as TG (mg/dL) * TC (mg/dL) * body weight (kg)/1,000. The primary outcome was an incidence of stroke. Multivariable adjusted models revealed an inverse association between TCBI and the prevalence of stroke. In the fully adjusted model, the results showed that the prevalence of stroke decreased by 13% (OR, 0.87; 95% CI, 0.78-0.98, p = 0.018) per SD increment of LgTCBI. When TCBI was assessed as a categorical variable, compared with those in group Q4 (TCBI ≥ 2,399), the participants in group Q3 (TCBI ≥ 1,476 and <2,399), group Q2 (TCBI ≥ 920 and <1,476), and group Q1 (TCBI < 920) had increases in stroke prevalence of 42% (OR, 1.42; 95% CI, 1.13-1.80; p-value = 0.003), 38% (OR, 1.38; 95% CI, 1.07-1.80; p-value = 0.014), and 68% (OR, 1.68; 95% CI, 1.24-2.27; p-value = 0.001), respectively. Subgroup analysis showed an interaction between age and TCBI and stroke (age < 60 years OR, 0.69; 95% CI, 0.58-0.83; vs. age ≥ 60 years OR, 0.95; 95% CI, 0.84-1.07; P for interaction = 0.001).

Conclusion

We found an independent negative association between TCBI and the prevalence of stroke, especially in hypertensive patients aged < 60 years.

Association between the geriatric nutritional risk index and the risk of stroke in elderly patients with hypertension: A longitudinal and cohort study

Objective

We aimed to investigate the association between the GNRI and the risk of stroke in elderly patients with hypertension.

Methods

A total of 5312 elderly hypertensive patients free of history of stroke were included. Multivariate Cox models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs) for stroke and its subtypes.

Results

The average time of follow-up was 3.8 years, and the median time was 3.2 years. We identified 640 individuals with stroke, of whom 526 had an ischemic stroke (IS) and 114 had a hemorrhagic stroke (HS). After adjusting for confounding variables, compared with participants in the lowest quartile of the GNRI, those in the third and fourth quartiles were associated with a decreased risk of stroke (adjusted HR 0.72, 95% CI 0.58-0.90, and adjusted HR 0.58, 95% CI 0.46-0.74, respectively, P for trend < 0.001). Similar results were found for IS and HS. Moreover, there were L-shaped associations of GNRI with new-onset HS (P for non-linearity = 0.034). Multiple sensitivity analyses and stratified analyses did not materially change the results.

Conclusions

In summary, we found that a lower GNRI was associated with a higher risk of incident stroke in elderly hypertensive patients. Additional prospective data collection is required to confirm our findings.

Prognostic value of the geriatric nutritional index in colorectal cancer patients undergoing surgical intervention: A systematic review and meta-analysis

BACKGROUND

We reviewed the literature to assess the prognostic ability of the geriatric nutritional risk index (GNRI) for patients with colorectal cancer (CRC) undergoing curative surgery.

METHODS

The online databases of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar were searched for articles reporting the relationship between GNRI and outcomes in CRC patients. English language studies were searched up to 28th April 2022.

RESULTS

Ten studies with 3802 patients were included. Meta-analysis indicated that patients with low GNRI had significantly poor overall survival (HR: 2.41 95% CI: 1.72, 3.41 I2 = 68%) and disease-free survival (HR: 1.92 95% CI: 1.47, 2.49 I2 = 49%) as compared to those with high GNRI. The meta-analysis also indicated a significantly higher risk of complications with low GNRI as compared to high GNRI (HR: 1.98 95% CI: 1.40, 2.82 I2 = 0%). The results did not change on subgroup analysis based on study location, age group, GNRI cut-off, and sample size.

CONCLUSION

Current evidence indicates that GNRI can be a valuable prognostic indicator for CRC patients undergoing surgical intervention. Patients with low GNRI have poor overall and disease-free survival and a higher incidence of complications. Clinicians could use this simple indicator to stratify patients and formulate personalized treatment plans.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier (CRD42022328374).

The Predictive Value of Different Nutritional Indices Combined with the GRACE Score in Predicting the Risk of Long-Term Death in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Nutritional status is associated with prognosis in acute coronary syndrome (ACS) patients. Although the Global Registry of Acute Coronary Events (GRACE) risk score is regarded as a relevant risk predictor for the prognosis of ACS patients, nutritional variables are not included in the GRACE score. This study aimed to compare the prognostic ability of the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) in predicting long-term all-cause death in ACS patients undergoing percutaneous coronary intervention (PCI) and to determine whether the GNRI or PNI could improve the predictive value of the GRACE score. A total of 799 patients with ACS who underwent PCI from May 2018 to December 2019 were included and regularly followed up. The performance of the PNI in predicting all-cause death was better than that of the GNRI [C-index, 0.677 vs. 0.638, p = 0.038]. The addition of the PNI significantly improved the predictive value of the GRACE score for all-cause death [increase in C-index from 0.722 to 0.740; IDI 0.006; NRI 0.095; p < 0.05]. The PNI was superior to the GNRI in predicting long-term all-cause death in ACS patients undergoing PCI. The addition of the PNI to the GRACE score could significantly improve the prediction of long-term all-cause death.

Low geriatric nutritional risk index is a risk factor for death within 1 year following hip fracture

PURPOSE

Hip fracture is common in older patients and is associated with high mortality and functional impairment. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications, and the Barthel Index (BI) evaluates older patients' functional status. The study aim was to determine the risk factors for both death and decreased BI within 1 year after hip fracture.

METHODS

We retrospectively reviewed the records of 108 patients who were treated for hip fractures in 10 public or private hospitals from February to July 2007. Participating facilities comprised eight public or private hospitals with 200-499 beds, and two private or orthopedic hospitals with 20-199 beds. We evaluated several risk factors for death and lower BI within 1 year after hip fracture.

RESULTS

The mortality rate within 1 year postoperatively for patients who survived inpatient stay was 6.5% (7/108). The proportion of patients with decreased postoperative BI was 43.6% (44/101). Binomial logistic regression analysis showed that several factors, including low GNRI (odds ratio [OR]: 0.80; 95% confidence interval [CI: 0.68-0.93]), were risk factors for death within 1 year. Postoperative delirium (OR: 8.84 [1.52-51.6]), postinjury dementia (OR: 34.8 [3.01-402]), preinjury BI (OR: 1.05 [1.02-1.08]), and preinjury dementia (OR: 6.22 [1.73-22.4]) were risk factors for decreased postoperative BI.

CONCLUSIONS

Our findings indicated that lower GNRI was a risk factor for death within 1 year of hip surgery and that delirium and dementia were among the risk factors for decreased BI 1 year after hip fracture.

Associations of the Geriatric Nutritional Risk Index With Femur Bone Mineral Density and Osteoporosis in American Postmenopausal Women: Data From the National Health and Nutrition Examination Survey

Background

The geriatric nutritional risk index (GNRI) has been used as a significant tool to access the nutritional status of the elderly. However, the relationship between the GNRI and femur bone mineral density (BMD) and the risk of osteoporosis remains unclear in American postmenopausal women.

Objectives

We aimed to explore associations between the GNRI with femur BMD and the risk of osteoporosis in American postmenopausal women.

Methods

We merged the continuous National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 to ensure a large and representative sample, including 3,152 participants. The linear relationship between the GNRI and femur BMD was assessed via a weighted multivariate linear regression model. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between the GNRI and the risk of osteoporosis were assessed by a weighted logistic regression model. Moreover, the nonlinear relationship was also characterized by smooth curve fitting (SCF) and a weighted generalized additive model (GAM).

Results

After adjusting for all covariates, the weighted multivariable linear regression models demonstrated that the GNRI was positively correlated with femur BMD. The weighted logistic regression models demonstrated that each unit of increased GNRI value was associated with a decreased risk of osteoporosis of 4.13%. When categorizing GNRI based on quartiles, ORs between the risk of osteoporosis and the GNRI across quintiles 2, 3, and 4 compared with quintile 1 were 0.5565 (95% CI: 0.4791, 0.6463; P &lt; 0.000001), 0.5580 (95% CI: 0.4600, 0.6769; P &lt; 0.000001), and 0.3475 (95% CI: 0.2681, 0.4505; P &lt; 0.000001). The trends similar to the above were also observed in SCF and GAM.

Conclusion

This study indicated that nutritional status, represented by the GNRI, was positively associated with femur BMD and negatively associated with the risk of osteoporosis in American postmenopausal women. The GNRI may be a good tool to identify American postmenopausal women who need further bone health nutritional support.

Nutritional indices at admission are associated with mortality rates of patients in the intensive care unit

BACKGROUND

Malnutrition is a common occurrence in critically ill patients, and has been related to poor prognosis in various diseases. Here, we assess the prognostic value of malnutrition using nutritional indices in intensive care units (ICU) patients.

METHODS

We retrieved information on 2060 patients from the Medical Information Mart for Intensive Care III, and randomized the patients into training and validation cohorts, at a ratio of 7:3. We estimated their nutritional indices using prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) score. Both multivariate regression analysis and the Kaplan-Meier (KM) survival curve were used to examine the prognostic role of nutritional indices in ICU mortality. Then we evaluated the additional predictive significance of each nutritional index beyond the baseline model including conventional risk factors.

RESULTS

Multivariate regression analysis revealed that PNI, GNRI, and CONUT were independent predictors of in-hospital and 1-year mortality (all P < 0.001). KM curves showed higher 1-year mortality rates in having nutritional risk patients (PNI ≤ 38 or GNRI ≤ 98 or CONUT ≥ 2). Moreover, subgroup analyses revealed a significant association between each nutritional index and 1-year mortality in patients with different comorbidities. We also observed a pronounced additional impact on the predictive value of 1-year mortality when PNI, GNRI, and CONUT were separately added to the baseline model. The additional role of each nutritional index was further verified in the validation cohort.

CONCLUSIONS

Our results revealed that the nutritional indices at admission are significantly correlated with increased mortality rates in ICU adult patients.

Predictors of Pacemaker-Induced Cardiomyopathy and Importance of Nutritional Status and Prognostic Nutritional Index

Background

Long-term right ventricular (RV) pacing may cause progressive left ventricular systolic dysfunction, and malnutrition is related to adverse cardiovascular outcomes in patients with heart failure. We aimed to evaluate the relationship between immunonutritional status and the development of pacing-induced cardiomyopathy (PICMP).

Methods

This study included 434 patients who underwent permanent pacemaker (PPM) implantation and had preserved left ventricular ejection fraction (LVEF) of > 40%. At six months of follow-up, the patients with LVEF < 40% were defined as having PICMP. Baseline prognostic nutritional index (PNI) was calculated based on serum albumin and lymphocyte count.

Results

Overall, 16.5% of the our study patients developed PICMP. The PICMP group had more males (p = 0.013), lower baseline LVEF values (p = 0.014) and lower baseline PNI levels (p < 0.001). RV pacing ratios and paced QRS intervals were higher in the PICMP group (p < 0.001 for both), but the types of implanted pacemakers were similar for all patients (p = 0.709). According to regression analyses, baseline LVEF (p = 0.020), PNI (p < 0.001), C-reactive protein level (p = 0.012), RV pacing ratio (p < 0.001) and paced QRS interval (p = 0.001) were independent predictors of PICMP development. A cut-off PNI value ≤ 43.2 at the time of PPM implantation could predict PICMP development with a sensitivity of 85.5% and specificity of 86.7% (p < 0.001).

Conclusions

Identifying poor nutritional status using the PNI may be an important concept to predict PICMP development, and optimizing nutritional status might help to reduce adverse outcomes in these patients.

Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: Malnutrition has been shown to be associated with adverse cardiovascular outcomes in many patient populations.

Aims: To investigate the prognostic significance of malnutrition as defined by nutritional risk index (NRI) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and whether NRI could improve the GRACE score based prognostic models.

Methods: This study applied NRI among 1,718 patients with ACS undergoing PCI. Patients were divided into three nutritional risk groups according to their baseline NRI: no nutritional risk (NRI ≥ 100), mild nutritional risk (97.5 ≤ NRI <100), and moderate-to-severe nutritional risk (NRI <97.5). The primary endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization.

Results: During a median follow-up of 927 days, 354 patients developed MACE. In the overall population, compared with normal nutritional status, malnutrition was associated with increased risk for MACE [adjusted HR for mild and moderate-to-severe nutritional risk, respectively: 1.368 (95%CI 1.004–1.871) and 1.473 (95%CI 1.064–2.041)], and NRI significantly improved the predictive ability of the GRACE score for MACE (cNRI: 0.070, P = 0.010; IDI: 0.005, P < 0.001). In the diabetes subgroup, malnutrition was associated with nearly 2-fold high adjusted risk of MACE, and the GRACE score combined with NRI appeared to have better predictive ability than that in the overall population.

Conclusion: Malnutrition as defined by NRI was independently associated with MACE in ACS patients who underwent PCI, especially in individuals with diabetes, and improved the predictive ability of the GRACE score based prognostic models.

Malnutrition Increases the Risk of Left Ventricular Remodeling

OBJECTIVES

Malnutrition is associated with increased incidence of heart failure (HF). Left ventricular (LV) remodeling is one of the most important processes in the occurrence and evolution of HF. However, the association between nutritional status and LV remodeling is not well known. The study aimed to investigate the association between malnutrition and LV remodeling.

DESIGN

The study was a retrospective observation study.

SETTING AND PARTICIPANTS

We included patients from the registry of Cardiorenal Improvement study from January 2007 to December 2018 at Guangdong Provincial People's Hospital.

MEASUREMENTS

The primary endpoint was LV remodeling, defined as an absolute decrease in LV ejection fraction ≥10% after discharge compared with baseline. Nutritional status was assessed by the Controlling Nutritional Status (CONUT) score. Eligible patients were divided into absent-mild malnutrition group (CONUT score ≤4) and moderate-severe malnutrition group (CONUT score >4). Univariable and multivariable logistic regression was performed to verify the association between malnutrition and left ventricular remodeling.

RESULTS

A total of 7,217 patients (mean age 61.3±10.5 years, 71.7% male) were included in the final analysis, among which 712 (9.9%) had LV remodeling. The incidence of LV remodeling in moderate-severe malnutrition group was significantly higher than that in absent-mild malnutrition group (12.9% vs. 9.5%, p=0.002). In multivariable logistic regression, moderate-severe malnutrition group was significantly associated with 1.69-fold increased risk of LV remodeling after adjusting confounders (OR: 1.69, CI: 1.32-2.16). Similar results were observed in subgroup stratified by age, gender, and coronary artery disease.

CONCLUSION

Nearly one eighth of patients were classified as moderate-severe malnutrition, 12% of whom had LV remodeling. Moderate-severe malnutrition was associated with 69% increased risk of LV remodeling. Further studies are needed to prospectively evaluate the nutrition-oriented managements on outcomes in LV remodeling.

Predictive Value of Geriatric Nutritional Risk Index in Patients With Coronary Artery Disease: A Meta-Analysis

Background: Low Geriatric Nutritional Risk Index has been identified as an index of impaired nutritional state. The objective of the meta-analysis was to assess the association of the Geriatric Nutritional Risk Index (GNRI) with adverse outcomes in patients with coronary artery disease (CAD).

Methods: Relevant studies were identified by comprehensively searching PubMed and Embase databases in May 2021. Studies assessing the association of GNRI with all-cause mortality or major adverse cardiovascular events (MACEs) in patients with CAD were included. The predictive value of GNRI was summarized by pooling multivariable adjusted risk ratios (RR) with 95% confidence intervals (CI) per GNRI point decrease or the lowest vs. the highest GNRI group.

Results: A total of eight studies involving 9277 patients with CAD were analyzed. Meta-analysis showed that the lowest GNRI was associated with a higher risk of all-cause mortality (RR 2.10; 95% CI 1.68–2.63) and MACEs (RR 2.84; 95% CI 1.56–5.16), respectively. Furthermore, per point decrease in GNRI was associated with 8 and 10% additional risk of all-cause mortality and MACEs. Subgroup analysis indicated that the value of low GNRI in predicting all-cause mortality was not affected by subtype of patients or follow-up duration.

Conclusion: Low GNRI score at baseline was associated with a higher risk of all-cause mortality and cardiovascular events in patients with CAD. The nutritional state estimated by the GNRI score could provide important predictive information in patients with CAD.

Impact of the Geriatric Nutritional Risk Index in Patients Undergoing Transcatheter Aortic Valve Implantation

Several studies have shown that nutritional indexes are associated with cardiovascular events; however, limited studies have investigated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to evaluate the clinical impact of GNRI in patients undergoing TAVI. This single-center retrospective study analyzed consecutive patients treated with TAVI, stratified into groups according to their median baseline GNRI. The primary endpoint was 2-year all-cause mortality. In total, 968 patients with a mean age of 82.1 years and a median Society of Thoracic Surgeons (STS) score of 4.8% who underwent TAVI were included. The median GNRI was 103. Compared with the high-GNRI group (GNRI≥103, n = 451), the low-GNRI group (GNRI<103, n = 517) had higher STS scores and renal insufficiency rates. The 2-year all-cause mortality was significantly higher in the low-GNRI group than in the high-GNRI group (24.9% vs. 9.3%, p<0.001), despite no significant differences in procedural and clinical outcomes between the groups. On multivariable analysis, lower GNRI was independently associated with higher 2-year all-cause mortality (adjusted hazard ratio: 1.07; 95% confidence interval: 1.05-1.10; p<0.001). The GNRI retained its predictive value in subgroup analyses stratified by age (>75 vs. ≤75 years) and STS score (≥4 vs. <4). In conclusion, The GNRI is an important surrogate marker for predicting prognosis and mortality in patients undergoing TAVI.

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy: Efficacy of the pretreatment Geriatric Nutritional Risk Index for predicting severe adverse events

OBJECTIVE

The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool. Although concurrent chemoradiotherapy (CCRT), particularly cisplatin-based CCRT, is a standard treatment for locoregional advanced head and neck squamous cell carcinoma (HNSCC), the predictive factors of adverse events related to CCRT remain to be elucidated. The present study aimed to determine the association between GNRI and CCRT-related adverse events in patients of all ages with head and neck cancer (HNC) who underwent CCRT.

METHODS

We retrospectively analyzed and compared the clinical characteristics and adverse events of 82 patients with HNC treated with CCRT according to their GNRI at the Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba Hospital, between May 2014 and November 2019. The GNRI was calculated according to the equation: 1.489 × serum albumin (g/L) + 41.7 × (body weight/ideal body weight). We compared two groups: low GNRI (GNRI < 98) and normal GNRI (GNRI ≥ 98) groups.

RESULTS

Eighty-two patients were enrolled in this study. There were 61 (76%) and 21 (26%) patients in the normal GNRI group and low GNRI group, respectively. There were significant differences in the incidence of grade ≥ 3 radiation mucositis, radiation dermatitis, and leukopenia between the low GNRI group and the normal GNRI groups.

CONCLUSIONS

Patients with low GNRI scores were more likely to have severe adverse events. Pretreatment GNRI predicted severe CCRT-related adverse events in patients of all ages with HNC undergoing CCRT.

Value of prognostic nutritional index for survival prediction in trans-catheter aortic valve replacement compared to other common nutritional indexes

BACKGROUND

Nutritional status predicts outcomes after TAVR. Predictive value of Prognostic Nutritional Index (PNI) was investigated in patients undergoing TAVR, and compared to other nutritional indexes.

METHODS

A cohort of 114 patients undergoing TAVR in a high-volume centre was studied. A prospective 1-year follow-up was completed. PNI was estimated as follows: (10 × serum albumin[g/dl])+(0.005 × total lymphocytes [1000/μl]). One-year survival was compared in patients with PNI above vs below median; Kaplan-Meier curves were created. A multivariate analysis was used to assess predictive value of PNI for 1-year mortality. ROC curves were used to assess discrimination by PNI, and to compare it with Geriatric Nutritional Risk Index (GNRI) and Body Mass Index (BMI).

RESULTS

Mean age was 82.2 years, 59.6% were male. Mean PNI was 46 ± 5. Pre-procedurally, no differences were found between patients with high vs. low PNI. One-year mortality was significantly higher in patients with low PNI values (19/57 vs. 4/57; p < .001). Complications did not differ. A higher PNI predicted 1-year survival, even after adjusting for clinical factors (model 1: HR 0.8, 95% CI 0.7-0.9, p < .0001) and laboratory parameters (NT-proBNP, IL-6, CRP, eGFR, cystatin C, haemoglobin) (model 2: HR 0.8, 95% CI 0.7-0.9, p < .05). ROC curves revealed a stronger predictive value for PNI (AUC 0.80) compared to GNRI (0.77) and BMI (0.6). The optimal cut-off for PNI was 45.

CONCLUSION

PNI is a useful and practical nutritional marker reflecting malnutrition and inflammation prior to the intervention, and strongly predicts 1-year survival. PNI seems to be a better prognostic marker than BMI or GNRI after TAVR.

Impact of the Malnutrition on Mortality in Elderly Patients Undergoing Percutaneous Coronary Intervention

Purpose

Malnutrition has been shown to be related to adverse clinical outcomes in patients with heart failure, hypertension, atrial fibrillation and other cardiovascular diseases. However, in the patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCI), especially in the elderly, the association of nutritional state and all-cause mortality remains unknown. We aimed to investigate the association of malnutrition with all-cause mortality in the elder patients undergoing PCI.

Patients and Methods

Based on the largest retrospective and observational cohort study from January 2007 to December 2017, the Controlling Nutritional Status (CONUT) score was applied to 21,479 consecutive patients with age ≥60 who undergoing PCI for nutritional assessment. Participants were classified as absent, mild, moderate and severe malnutrition by CONUT score. The Kaplan-Meier method was used to compare all-cause mortality among the above four groups. Multivariable Cox proportional hazard regression analyses were performed to examine the association of malnutrition with all-cause mortality.

Results

According to the CONUT score, 48.19%, 15.08% and 0.94% patients were mildly, moderately and severely malnourished, respectively. During a median follow-up of 5.16 years (interquartile range: 3.02 to 7.89 years), 3173 (14.77%) patients died. Kaplan-Meier analysis showed that the risk of all-cause mortality was significantly higher in patients with a worse nutritional status. Compared with normal nutritional state, malnutrition was associated with significantly increased risk for all-cause mortality (adjusted hazard ratio for mild, moderate and severe degrees of malnutrition, respectively: 1.20 [95% confidence interval (CI): 1.09 to 1.33], 1.32 [95% CI: 1.17 to 1.49] and 1.76 [95% CI: 1.33 to 2.33]).

Conclusion

Malnutrition is prevalent among elderly patients with CAD undergoing PCI, and is strongly related to the all-cause mortality increasing. For elderly patients with CAD undergoing PCI, it is necessary to assess the status of nutrition, and evaluate the efficacy of nutritional interventions.

Geriatric nutritional risk index as a predictor of arrhythmia recurrence after catheter ablation of atrial fibrillation

BACKGROUND AND AIMS

The nutritional risk of patients who undergo atrial fibrillation (AF) ablation varies. Its impact on the recurrence after ablation is unclear. We sought to evaluate the relationship between the nutritional risk and arrhythmia recurrence in patients who undergo AF ablation.

METHODS AND RESULTS

We enrolled 538 patients (median 67 years, 69.9% male) who underwent their first AF ablation. Their nutritional risk was evaluated using the pre-procedural geriatric nutritional risk index (GNRI), and the patients were classified into two groups: No-nutritional risk (GNRI ≧ 98) and Nutritional risk (GNRI < 98). The primary endpoint was a recurrence of an arrhythmia, and its relationship to the nutritional risk was evaluated. We used propensity-score matching to adjust for differences between patients with a GNRI-based nutritional risk and those without a nutritional risk. A nutritional risk was found in 10.6% of the patients, whereas the remaining 89.4% had no-nutritional risk. During a mean follow-up of 422 days, 91 patients experienced arrhythmia recurrences. The patients with a nutritional risk had a significantly higher arrhythmia recurrence rate both in the entire study cohort (Log-rank p = 0.001) and propensity-matched cohort (Log-rank p = 0.006). In a Cox proportional hazard analysis, the nutritional risk independently predicted arrhythmia recurrences in the entire study cohort (hazard ratio [HR]: 3.91, 95% confidence interval [CI]: 1.84-8.35, p < 0.001) and propensity-matched cohort (HR: 6.49, 95% CI: 1.42-29.8, p = 0.016).

CONCLUSION

A pre-procedural malnutrition risk was significantly associated with increased arrhythmia recurrences in patients who underwent AF ablation.

Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases

Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed.

Association between geriatric nutrition risk index and bone mineral density in elderly Chinese people

Malnutrition contributes to the occurrence of osteoporosis. This study showed that participants with higher GNRI values had higher levels of BMD. GNRIs were positively correlated with BMD and independently associated with total hip T-score. GNRIs may be a good indicator for identifying elderly who need further bone health nutritional support.

PURPOSE

To evaluate the relationship between geriatric nutrition risk index (GNRI) and bone mineral density (BMD) in elderly Chinese people.

METHODS

We recruited 1130 older adults (60-89 years old) between May 2018 and December 2019. Participants underwent clinical, laboratory, and densitometry examinations. Dual-energy x-ray absorptiometry densitometers and corresponding software were used to assess the BMD and T-scores of participants. Differences between study groups were assessed using one-way analysis of variance (ANOVA) for continuous variables and the chi-square test for categorical variables. Pearson's correlation coefficient was used to assess the correlation between two variables. Multivariate linear regressions with or without adjustments were constructed to explore the possible confounding variables.

RESULTS

Individuals with higher GNRI values had higher total hip and lumbar spine T-scores (P < 0.001, P = 0.029, respectively). Pearson's correlation demonstrated that GNRIs were positively correlated with BMD at different anatomical sites, in both sexes but especially in women. A multiple regression demonstrated that GNRIs were independently associated with total hip T-score in both sexes (β = 0.111 for men and 0.174 for women; P = 0.034 and 0.008, respectively).

CONCLUSIONS

Elderly people with higher GNRI values had higher total hip and lumbar spine T-scores, which suggested that GNRI is closely related to BMD. This relationship is maintained at the total hip, even after fully adjusting for possible confounding variables, and consequently, it may be a good indicator for identifying older people who need further bone health nutritional support.

The impact of malnutrition on atrial fibrillation recurrence post ablation

BACKGROUND AND AIMS

Both malnutrition and atrial fibrillation (AF) are the major health problems in modern society. Only a few studies focused on the relationship between malnutrition and recurrence of atrial arrhythmias post AF ablation (AF recurrence), which used body mass index (BMI) as nutrition assessment tool. However, BMI can't credibly reflect body composition and has limitation in patients with water-sodium retention. In this study, we used controlling nutritional status score (CONUT score) and geriatric nutritional risk index (GNRI) to identify the malnutrition patients and explored the effect of malnutrition on AF recurrence.

METHODS AND RESULTS

This retrospective study included 246 patients who underwent AF ablation. During a median 11-month follow-up, 77 patients (31.3%) experienced AF recurrence. The recurrence group had higher CONUT score (2.3 ± 1.5 vs. 0.9 ± 1.0, P < 0.001) and lower GNRI (99.9 ± 7.6 vs. 103.9 ± 5.6, P < 0.001). After balancing the traditional risk factors, both CONUT score (OR: 2.614, 95%CI: 1.831-3.731, P < 0.001) and GNRI (OR: 0.884, 95%CI: 0.828-0.944, P < 0.001) were the independent predictors for AF recurrence. Pre-ablation CONUT score ≥1 and GNRI≥95.66 are indicative of AF recurrence. Adding CONUT score or GNRI to the base prediction model for AF recurrence significantly improved the discrimination and calibration. However, adding BMI to the base prediction model did not improve the model performance.

CONCLUSIONS

CONUT score and GNRI are ideal tools to evaluate the nutrition status of AF patients. Undernourished patients are more likely to suffer from AF recurrence. Improving nutrition status may be a potential target for reducing the postoperative recurrence rate.

The long-term prognostic factors in hemodialysis patients with acute coronary syndrome: perspectives from sarcopenia and malnutrition

Hemodialysis (HD) patients tend to have sarcopenia and malnutrition, and both conditions are related to poor prognosis in the cardiovascular disease that often accompanies HD. However, the impact of sarcopenia or malnutrition on the long-term prognosis of HD patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains unclear. We analyzed 1,605 consecutive patients with ACS who had undergone PCI at a single center between January 2009 and December 2014. We evaluated all-cause mortality and prognosis-associated factors, including sarcopenia/malnutrition-related factors such as the Geriatric Nutritional Risk Index (GNRI), and Skeletal Muscle Mass Index (SMI). After exclusions, 1461 patients were enrolled, and 58 (4.0%) were on HD. The HD group had lower levels of SMI and GNRI than non-HD group, and had worse in-hospital prognosis. Moreover, HD group had a significant higher mortality in the long-term follow-up [median follow-up period: 1219 days; Hazard Ratio (HR) = 4.09, p < 0.001]. After adjusting the covariates, SMI and GNRI were the factors associated with all-cause mortality in all patients [SMI: adjusted HR (aHR) = 2.39, p = 0.036; GNRI: aHR = 2.21, p = 0.006]; however, these findings were not observed among HD patients with ACS, and only diabetes was significantly associated with all-cause mortality (diabetes: aHR = 3.50, p = 0.031). HD patients with ACS had a significantly higher rate of in-hospital and long-term mortality than non-HD patients. Although sarcopenia and malnutrition were related to mortality and were more common in HD patients, sarcopenia and malnutrition had a lower impact than diabetes on the long-term prognosis of HD patients with ACS.

Malnutrition is independently associated with an increased risk of major cardiovascular events in adult patients with congenital heart disease

BACKGROUND AND AIMS

Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown.

METHODS AND RESULTS

A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17-35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2-4.7) g/dL, the body mass index was 23 (21-27) kg/m², the NRI was 112 (106-118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5-10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04-1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17-8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93-0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration.

CONCLUSIONS

A low NRI is independently associated with a significant increased risk of MACE in CHD patients.

Prognostic value of malnutrition using geriatric nutritional risk index in patients with coronary chronic total occlusion after percutaneous coronary intervention

BACKGROUND

Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known.

AIMS

This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI).

METHODS

Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI): moderate to severe, GNRI of <92 (n = 70); low, GNRI of 92-98 (n = 197); and absence of risk, GNRI of ≥98 (n = 402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE).

RESULTS

Average age in this study was 65.32 ± 9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe: 10.5%; low: 29.4%; and absence of risk: 60.1%). Over a median follow-up of 33 months, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the all-cause death, cardiovascular death and MACE (hazard ratio [HR]: 2.90, 95% confidence interval [CI]: 1.43 to 5.87, P for trend = 0.002; HR: 3.72, 95% CI: 1.42 to 9.77, P for trend = 0.010; HR: 1.76, 95% CI: 1.02 to 3.03, P for trend = 0.040; respectively) after adjustment for baseline variables. Moreover, addition of the GNRI score significantly raised the predictive value for the all-cause death (0.383, p = 0.004 and 0.022, p = 0.011, NRI and IDI respectively), cardiovascular death (0.488, p < 0.001 and 0.013, p = 0.014, NRI and IDI respectively) and MACE (0.368, p = 0.004 and 0.014, p = 0.008, NRI and IDI respectively) as compared to traditional factors.

CONCLUSIONS

Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.

Nutritional status and severity of coronary artery disease

OBJECTIVE

The aim of this study is to evaluate the association between Nutritional Risk Index (NRI), a simple tool to assess nutritional status, and coronary artery disease severity and complexity in patients undergoing coronary angiography.

METHODS

This study is a retrospective analysis of 822 patients undergoing coronary angiography. Patients with previous revascularization were excluded. Gensini and SYNTAX scores were calculated according to the angiographic images to determine atherosclerosis severity. NRI was calculated as follows: NRI = [15.19 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. In patients ≥65 years of age, Geriatric NRI (GNRI) was used instead of NRI. GNRI was calculated as follows: GNRI = [14.89 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. Patients were then divided into three groups as previously reported: NRI < 92, NRI 92-98 and NRI > 98. Gensini and SYNTAX scores were compared between three groups.

RESULTS

The mean age of study population was 61.9 ± 11.1 years. NRI < 92, 92-98, and >98 was measured in 212, 321 and 289 patients, respectively. There was no difference regarding to sex, BMI, smoking, hypertension and diabetes mellitus between three groups. Patients with NRI < 92 had the highest mean Gensini score than the patients with NRI 92-98 and NRI > 98 (38.0 ± 40.6 vs. 31.17 ± 42.4 vs. 25.8 ± 38.4, P = 0.005). Also patients with NRI < 92 had the highest mean SYNTAX score than the patients with NRI 92-98 and NRI > 98 (11.8 ± 12.9 vs. 9.3 ± 12.4 vs. 7.7 ± 11.8, P = 0.001). Also, Gensini score of ≥20 and high SYNTAX score of ≥33 were associated with lower NRI (P < 0.001 and P < 0.001, respectively).

CONCLUSION

In our study, nutritional status evaluated by the NRI was associated with more extensive and complex coronary atherosclerosis in patients undergoing coronary angiography.

Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure

The TCB index (triglycerides × total cholesterol × body weight), a novel simply calculated nutritional index based on serum triglycerides (TGs), serum total cholesterol (TC), and body weight (BW), was recently reported to be a useful prognostic indicator in patients with coronary artery disease. Thus, this study aimed to investigate the relationship between TCBI and long-term mortality in acute decompensated heart failure (ADHF) patients. Patients with a diagnosis of ADHF who were consecutively admitted to the cardiac intensive care unit in our institution from 2007 to 2011 were targeted. TCBI was calculated using the formula TG (mg/dL) × TC (mg/dL) × BW (kg)/1000. Patients were divided into two groups according to the median TCBI value. An association between admission TCBI and mortality was assessed using univariable and multivariable Cox proportional hazard analyses. Overall, 417 eligible patients were enrolled, and 94 (22.5%) patients died during a median follow-up period of 2.2 years. The cumulative survival rate with respect to all-cause, cardiovascular, and cancer-related mortalities was worse in patients with low TCBI than in those with high TCBI. In the multivariable analysis, although TCBI was not associated with cardiovascular and cancer mortalities, the association between TCBI and reduced all-cause mortality (hazard ratio: 0.64, 95% confidence interval: 0.44-0.94, p = 0.024) was observed. We computed net reclassification improvement (NRI) when TCBI or Geriatric Nutritional Risk Index (GNRI) was added on established predictors such as hemoglobin, serum sodium level, and both. TCBI improved discrimination for all-cause mortality (NRI: 0.42, p < 0.001; when added on hemoglobin and serum sodium level). GNRI can improve discrimination for cancer mortality (NRI: 0.96, p = 0.002; when added on hemoglobin and serum sodium level). TCBI, a novel and simply calculated nutritional index, can be useful to stratify patients with ADHF who were at risk for worse long-term overall mortality.

Impacts of geriatric nutritional risk index on prognosis of patients with non-ST-segment elevation acute coronary syndrome: Results from an observational cohort study in China

BACKGROUND AND AIMS

It is recognized that malnutrition increases risk of worse prognosis in patients with various diseases. The present study investigated if poor nutritional status predicts adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).

METHODS AND RESULTS

The study enrolled 2299 patients (mean age: 60.01 ± 8.95 years; 71.8% male) with NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. The entire cohort was divided into training set (n = 1519) and testing set (n = 780) at a ratio of approximate 2 : 1. Nutritional status was assessed by geriatric nutritional risk index (GNRI). The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and any revascularization. Multivariate Cox analysis showed that GNRI significantly associated with primary endpoint, independent of other risk factors [hazard ratio (HR) 1.159 per 1-point decrease of GNRI, 95% confidence interval (CI) 1.130-1.189, p < 0.001]. The addition of GNRI to a baseline model had an incremental effect on the predictive value for adverse prognosis in training set [AUC: from 0.821 to 0.873, p < 0.001; category-free net reclassification improvement (NRI): 0.313, p < 0.001; integrated discrimination improvement (IDI): 0.108, p < 0.001]. The incremental effect of GNRI was further validated and confirmed in testing set.

CONCLUSION

Lower GNRI is a significant predictor of adverse prognosis in patients with NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether nutritional interventions have a positive impact on improving clinical prognosis.

Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis

BACKGROUND

We evaluated the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in second-line pembrolizumab (PEM) therapy for patients with metastatic urothelial carcinoma (mUC).

PATIENTS AND METHODS

From January 2018 to October 2019, 52 mUC patients, treated previously with platinum-based chemotherapy, underwent second-line PEM therapy. Peripheral blood parameters were measured at the start of treatment: serum neutrophil-to-lymphocyte ratio (NLR), serum albumin, serum C-reactive protein (CRP), and body height and weight. PEM was intravenously administered (200 mg every 3 weeks). The patients were organized into two groups based on their GNRI (<92 [low GNRI] and ≥92 [high GNRI]), and the data were retrospectively analyzed. Adverse events (AEs) were evaluated and imaging studies assessed for all patients. Analyses of survival and recurrence were performed using Kaplan-Meier curves. Potential prognostic factors affecting cancer-specific survival (CSS) were assessed by univariate and multivariate Cox regression analyses.

RESULTS

patients' baseline characteristics, except for their BMI and objective response rate, did not significantly differ between the two groups. The median total number of cycles of PEM therapy was significantly higher for the high-GNRI group (n [range]: 6 [2-20] vs. 3 [1-6]). The median CSS with second-line PEM therapy was 3.6 months (95% confidence interval [CI]: 2.5-6.1) and 11.8 months (95% CI: 6.2-NA) in the low-GNRI and the high-GNRI group (p < 0.01), respectively. Significant differences in CSS between the low- and high-CRP or -NRL groups were not found. Multivariate Cox proportional-hazards regression analysis revealed that a poor Eastern Cooperative Oncology Group performance status, visceral metastasis, and a low GNRI were significant prognostic factors for short CSS (95% CI: 1.62-6.10, HR: 3.14; 95% CI: 1.13-8.11, HR: 3.03; 95% CI: 1.32-8.02, HR: 3.25, respectively). Of the AEs, fatigue showed a significantly higher incidence in the low-GNRI group.

CONCLUSIONS

For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.

Hospital malnutrition in northeast and southeast Asia: A systematic literature review

BACKGROUND & AIMS

Hospital malnutrition is a prevalent yet frequently under-recognised condition that is associated with adverse clinical and economic consequences. Systematic reviews from various regions of the world have provided regional estimates of the prevalence of malnutrition and the magnitude of the associated health and economic burden; however, a systematic assessment of the prevalence and consequences of hospital malnutrition in northeast and southeast Asia has not been conducted.

METHODS

We performed a systematic literature search for articles on hospital malnutrition in 11 Asian countries published in English between January 1, 1997 and January 15, 2018. Studies reporting data on the prevalence, clinical consequences, or economic impact of hospital malnutrition in an adult inpatient population with a sample size ≥30 were eligible for inclusion.

RESULTS

The literature search identified 3207 citations; of these, 92 studies (N = 62,280) met the criteria for inclusion. There was substantial variability in study populations and assessment methods; however, a majority of studies reported a malnutrition prevalence of >40%. Malnutrition was associated with an increase in clinical complications, mortality, length of hospitalisation, hospital readmissions, and healthcare costs.

CONCLUSIONS

Hospital malnutrition is a highly prevalent condition among hospitalised patients in northeast and southeast Asia. Additionally, poor nutritional status is associated with increased morbidity and mortality and increased healthcare costs. Further research aimed at improving the identification and proactive management of hospitalised patients at risk for malnutrition is necessary to improve patient outcomes and alleviate the burden on local healthcare budgets.

Association between the Geriatric Nutritional Risk Index, bone mineral density and osteoporosis in type 2 diabetes patients

AIMS/INTRODUCTION

Low bodyweight and hypoalbuminemia are independently associated with osteoporosis. In this study, the relationship among the Geriatric Nutritional Risk Index (GNRI), bone mineral density (BMD) and osteoporosis in type 2 diabetes mellitus patients was explored, and the GNRI predictive value was evaluated.

MATERIALS AND METHODS

We enrolled 225 men and 192 women with type 2 diabetes mellitus. Their general condition, and laboratory and BMD data were collected. Spearman's partial correlation analysis adjusting for age, body mass index and albumin was used for exploring the association among the GNRI, BMD and bone metabolism markers. Statistical analyses, including multivariate regression analysis and receiver operating characteristic curve analysis, were also applied in this study.

RESULTS

On Spearman's partial correlation analysis, GNRI was positively associated with BMD and albumin-corrected calcium (r = 0.145-0.561, P < 0.01). For the multivariate regression analysis, we observed that the GNRI was dramatically related to high total lumbar, total hip, femur neck BMD and osteoporosis (odds ratio 0.857 for men and 0.927 for women, all P < 0.05). The area under the receiver operating characteristic curve of the GNRI (0.876 for men and 0.704 for women, all P < 0.01) was the largest compared with that of albumin and body mass index in osteoporosis prediction.

CONCLUSIONS

In this study, it was shown that the GNRI was positively correlated with BMD, and inversely correlated with osteoporosis in type 2 diabetes mellitus patients. In addition, compared with body mass index, albumin and age, the GNRI was a more powerful indicator for osteoporosis.

Impact of nutritional index on long-term outcomes of elderly patients with coronary artery disease: sub-analysis of the SHINANO 5 year registry

Nutritional status is a novel approach to prognostic assessment in patients with cardiovascular disease. However, assessment of nutritional status in elderly patients is challenging due to the significant differences between young patients. The TCBI (Triglycerides × Total cholesterol × Body Weight Index) is a novel and simple nutritional index for predicting long-term outcomes in patients with coronary artery disease. This retrospective study evaluated the efficacy of TCBI in 597 elderly (≥ 75 years) patients enrolled in the SHINANO 5 year registry. The SHINANO 5 year registry, a prospective observational multicenter cohort study, had enrolled 1501 consecutive patients who underwent elective/urgent percutaneous coronary intervention (PCI). In this study, patients were categorized into TCBI quartile groups. The primary endpoints were the occurrence of major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, and myocardial infarction at 5 year. The mean duration of follow up was 4.3 ± 1.7 years. The average patient age was 80.9 ± 4.3 years. MACCE was observed in 61 (40.9%) patients in the lowest TCBI quartile group. Kaplan–Meier analysis demonstrated an inverse relationship between MACCE and TCBI (log-lank P < 0.001). Multivariate analysis demonstrated that low TCBI significantly predicted the incidence of MACCE (hazard ratio: 1.44, 95% confidence interval: 1.03–2.00; P = 0.031). The TCBI is useful in predicting long-term outcomes in elderly patients undergoing PCI.

Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients

BACKGROUND

Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy.

METHODS

We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group.

RESULTS

Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS.

CONCLUSION

GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.

Usefulness of the Geriatric Nutritional Risk Index to predict the severity of cholecystitis among older patients in the emergency department

AIM

We sought to investigate whether the Geriatric Nutritional Risk Index is associated with systemic organ dysfunction among older patients who present with cholecystitis to the emergency department.

METHODS

This was an observational retrospective study among consecutive older patients with cholecystitis in the emergency department from 2012 to 2018. We collected baseline characteristics and laboratory data, and re-categorized the Geriatric Nutritional Risk Index into three risk groups. We carried out univariate and multivariate analyses to identify factors associated with systemic organ dysfunction. Logistic regression was used for statistical analysis.

RESULTS

A total of 303 patients were included in this study. The median age of participants was 74 years (interquartile range 68-79 years). The overall proportion of systemic organ dysfunction was 26.4%. The Geriatric Nutritional Risk Index was stratified as: ≥98 (n = 183, systemic organ dysfunction 15.3%), 87 to <98 (n = 90, systemic organ dysfunction 38.9%) and <87 (n = 30, systemic organ dysfunction 56.7%). Multivariate analysis using a logistic regression model showed that age, respiratory rate, temperature, geriatric nutritional risk index and quick Sepsis-related Organ Failure Assessment score in the emergency department were independently associated with systemic organ dysfunction in patients with cholecystitis.

CONCLUSIONS

The Geriatric Nutritional Risk Index was recognized as an independent factor associated with systemic organ dysfunction in older patients in the emergency department who presented with cholecystitis. This index might be helpful in screening patient risk and deciding whether to carry out further tests. Geriatr Gerontol Int 2020; 20: 455-460.

The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Head and Neck Cancer

OBJECTIVE

The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI <82); intermediate (GNRI 82-98); and normal (GNRI >98). The primary endpoint was overall survival.

RESULTS

A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]).

CONCLUSIONS

The GNRI could be considered a useful prognostic factor in patients with AHNC.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E151-E156, 2021.

Hypoalbuminemia and Obesity in Orthopaedic Trauma Patients: Body Mass Index a Significant Predictor of Surgical Site Complications

The purpose of this investigation was to identify the prevalence of hypoalbuminemia and obesity in orthopaedic trauma patients with high-energy injuries and to investigate their impact on the incidence of surgical site complications. Patients 18 years of age and older undergoing intramedullary nail fixation of their femoral shaft fractures at a university-based level-1 trauma centre were assessed. Malnutrition was measured using serum markers (albumin <3.5 g/dL) as well as body mass index (BMI) as a marker of obesity (BMI > 30 kg/m²). The primary outcome measure was surgical wound complications. A total of 249 patients were included in this study. Ninety-eight patients (39.4%) presented with hypoalbuminaemia and 80 patients (32.1%) were obese. The overall incidence of wound complications in our study population was 9.65% (n = 25/259). A logistic regression model showed that non-obese patients (BMI < 30 kg/m²) were at significantly reduced risk for perioperative wound complications (Odds Ratio 0.400 [95% confidence interval 0.168, 0.954], p = 0.039). This study demonstrated a substantial prevalence of hypoalbuminemia and obesity among orthopaedic trauma patients with high-energy injuries. Obesity may increase the risk of surgical site complications. Future studies are required to further define malnutrition and its correlation with surgical site complications in orthopaedic trauma patients.

Predictive value of the geriatric nutritional risk index in percutaneous coronary intervention with rotational atherectomy

The prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing percutaneous coronary intervention (PCI) with rotational atherectomy (RA) remains unknown. Therefore, we aimed to clarify whether the GNRI could predict major adverse cardiac events (MACE) in patients undergoing PCI with RA. A total of 206 patients who underwent PCI with RA from January 2009 to December 2017 were retrospectively tracked. The patients were divided into 2 groups based on the GNRI value on admission. MACE comprised all-cause death, target lesion revascularization (TLR), target vessel revascularization (TVR), and myocardial infarction. One year of follow up was completed in 95.6% of patients. During this period, 50 cases of MACE were observed (all-cause death, 32 cases; TLR, 21 cases; and TVR, 2 cases). Patients with a low GNRI (< 98) had a significantly higher incidence of MACE than did patients with a high GNRI (≥ 98) (37.9% vs. 15.5%, log-rank p < 0.05). The GNRI was an independent predictor of MACE (hazard ratio, 0.94; 95% confidence interval [CI], 0.92-0.97). Furthermore, the GNRI had better predictive power than did its components alone (i.e. body mass index and serum albumin level) (net-reclassification improvement, 0.39; 95% CI, 0.07-0.71; p = 0.01; integrated discrimination improvement, 0.02; 95% CI, - 0.01-0.04; p = 0.07). The GNRI on admission is a predictor of MACE after PCI with RA. Further studies are required to determine whether intensive medical therapy could improve clinical events, particularly cardiovascular death and revascularization, in this population.

The Prognostic Value of Preoperative Geriatric Nutritional Risk Index in Patients with Pancreatic Ductal Adenocarcinoma

Purpose

Patients with malignancy are more likely to develop nutritional problems. The Geriatric Nutritional Risk Index (GNRI) is a new prognostic index for evaluating nutritional status. The objective of this study was to assess if preoperative GNRI could be a prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC) who underwent radical surgery.

Patients and Methods

This study included 282 consecutive patients with incident pancreatic ductal adenocarcinoma who were treated with radical surgery. The Cox regression analysis was performed to calculate the overall survival (OS) and assess the prognostic factors. A nomogram was developed based on the results of the multivariate analysis, and the predictive accuracy of the nomogram was assessed.

Results

Among the 282 patients, there are 117 males and 165 females. The patients had a mean age of 58.7 ±13.5 years, with the median follow-up time of 72.9 months (interquartile range, 0.7 to 115.2 months). They were classified into abnormal (GNRI ≤ 98) and normal (GNRI > 98) GNRI groups, respectively. Multivariate Cox analysis showed that age (HR = 1.023), drinking history (HR = 1.453), tumor grade (HR = 1.633), TNM stage (HR = 1.921), and GNRI (HR = 1.757) were significantly associated with OS. Based on the above variables, the nomogram was established. The concordance index (C-index) and time-dependent receiver operating characteristics curve (tdROC) showed the nomogram was superior to TNM grade and tumor grade in predicting the OS of patients with PDAC.

Conclusion

GNRI could be a useful prognostic indicator in patients with PDAC who received surgery. Based on the GNRI and the other clinical indicators, we developed a nomogram model that can provide an accurate estimation of OS in patients with PDAC after radical surgery.

The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients

Purpose

The geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients.

Patients and Methods

The medical records of 230 CRC patients aged≥65 years who underwent surgery between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into abnormal and normal GNRI groups by modified binary classification. Logistic regression analysis was used to evaluate the correlation between GNRI and complication risk. The Kaplan–Meier method with log-rank test was used to construct survival curves. The Cox proportional hazard model was used for univariate, multivariate and subgroup survival analyses to assess the relationship between GNRI and long-term prognosis.

Results

Multivariate logistic regression analysis showed that GNRI (p = 0.009, HR 2.280, 95% CI: 1.224–4.247) was an independent risk factor for postoperative complications in elderly CRC patients. Kaplan–Meier survival curves revealed that the abnormal GNRI group had significantly lower disease-free survival (DFS; p = 0.005) and overall survival (OS; p=0.007) than the normal GNRI group had, especially in TNM I stage. In multivariate survival analysis, GNRI was an independent prognostic factor for DFS (p = 0.003, HR 1.842, 95% CI: 1.229–2.760) and OS (p = 0.003, HR 1.852, 95% CI: 1.231–2.787).

Conclusion

GNRI is a simple and effective tool for predicting the risk of postoperative complications and the long-term prognosis of postoperative elderly CRC patients and can provide a scientific basis for early nutrition interventions in elderly CRC patients.