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Kashiwagi S, Kanda N, Yoshida M, Wakimoto Y, Ohbe H, Nakamura K. Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients: A claims database study using a propensity score analysis. Clin Nutr 2024; 43:1872-1879. [PMID: 38968719 DOI: 10.1016/j.clnu.2024.06.033] [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: 02/13/2024] [Revised: 06/13/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND & AIMS Early enteral nutrition (EEN) potentially improves immune-related outcomes via the maintenance of intestinal immunity; however, the effects of EEN on clinical outcomes, including infectious complications, are controversial. Therefore, we herein investigated whether EEN affected persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which represents the immunocompromised state after critical illness. METHODS This retrospective cohort study utilized the administrative claims database of inpatients and laboratory findings. Patients admitted to and treated in the intensive care unit (ICU) for more than 3 consecutive days were included. The primary outcome, a composite of PICS or mortality on day 14 after admission, was compared between the EEN group, which received enteral nutrition (EN) on the first 3 days (day 0, 1, or 2), and the late enteral nutrition (LEN) group, which did not receive EN on the first 3 days, but then received EN on days 3 through 7, using a propensity score-matched analysis. Secondary outcomes included the composite outcome on day 28, in-hospital mortality, the Barthel index, and laboratory data. Patients who met at least two of the following conditions were diagnosed with PICS: CRP >2.0 mg/dL, albumin <3.0 g/dL, and a lymphocyte count <800/μL. RESULTS A total of 7530 matched pairs were generated after propensity score matching. The primary outcome was significantly lower in the EEN group (risk difference -3.0%, 95% confidence interval (CI) -4.5 to -1.4%), whereas mortality did not significantly differ. The 28-day composite outcome was similar in the 2 groups (risk difference -1.5%, 95% CI -2.8% to -0.2%, no significant difference in mortality). There was no significant difference in in-hospital mortality between the EEN and LEN groups; however, the Barthel index at discharge was higher in the EEN group (the medians, 50 vs 45, P = 0.001). Laboratory data showed lower Albumin and CRP on day 14 in the EEN group, but no other significant differences. CONCLUSIONS In patients admitted to the ICU, EEN was associated with a lower incidence of PICS on days 14 and 28, but was not associated with mortality. This positive association was not observed in sepsis, cardiac diseases, or gastrointestinal diseases.
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Affiliation(s)
- Shizuka Kashiwagi
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naoki Kanda
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan; Division of General Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Minoru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yuji Wakimoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Hiroyuki Ohbe
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nakamura
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan; Department of Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan.
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Yu J, Park JY, Kim CS, Lee BJ, Seo H, Park JB, Seo YJ, Kim YK. Geriatric Nutritional Risk Index and 30-Day Postoperative Mortality in Geriatric Burn Patients. J Surg Res 2024; 301:610-617. [PMID: 39094519 DOI: 10.1016/j.jss.2024.07.031] [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: 12/28/2023] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION The geriatric nutritional risk index (GNRI) can easily identify malnutrition-associated morbidity and mortality. We investigated the association between preoperative GNRI and 30-d mortality in geriatric burn patients who underwent surgery. METHODS The study involved geriatric burn patients (aged ≥ 65 y) who underwent burn surgery between 2012 and 2022. The GNRI was computed using the following formula: 1.489 × serum albumin concentration (mg/L) + 41.7 × patient body weight/ideal body weight. Patients were dichotomized into the high GNRI (≥ 82) and low GNRI (< 82) groups. GNRI was evaluated as an independent predictor of 30-d postoperative mortality. The study also evaluated the association between GNRI and sepsis, the need for continuous renal replacement therapy (CRRT), major adverse cardiac events (MACE), and pneumonia. RESULTS Out of 270 patients, 128 (47.4%) had low GNRI (< 82). Multivariate Cox regression analysis revealed that low GNRI was significantly associated with 30-d postoperative mortality (hazard ratio: 1.874, 95% confidence interval [CI]: 1.146-3.066, P = 0.001). Kaplan-Meier analysis revealed that the 30-day mortality rate differed significantly between the low and high GNRI groups (log-rank test, P < 0.001). The 30-d postoperative mortality (hazard ratio: 2.677, 95% CI: 1.536-4.667, P < 0.001) and the incidence of sepsis (odds ratio [OR]: 2.137, 95% CI: 1.307-3.494, P = 0.004), need for CRRT (OR: 1.919, 95% CI: 1.101-3.344, P = 0.025), MACE (OR: 1.680, 95% CI: 1.018-2.773, P = 0.043), and pneumonia (OR: 1.678, 95% CI: 1.019-2.764, P = 0.044), were significantly higher in the low GNRI group than in the high GNRI group. CONCLUSIONS Preoperative low GNRI was associated with increased 30-d postoperative mortality, sepsis, need for CRRT, MACE, and pneumonia in geriatric burn patients.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bong Jae Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong Bum Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Zheng T, Sun H, Tang Y, Zeng Y, Yan L. Association of lower urinary tract symptoms and geriatric nutritional risk index in men: a cross-sectional study based on NHANES. Front Med (Lausanne) 2024; 11:1356921. [PMID: 38975054 PMCID: PMC11224433 DOI: 10.3389/fmed.2024.1356921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/13/2024] [Indexed: 07/09/2024] Open
Abstract
Background Despite previous literature exploring the factors influencing lower urinary tract symptoms (LUTS), few studies have examined the relationship between nutritional status and LUTS. Objectives The objective of this research was to evaluate the relationship between LUTS and Geriatric Nutritional Risk Index (GNRI) in middle-aged and older men. Methods We included 2,607 men in the NHANES 2005-2006 and 2007-2008 cycles for cross-sectional analysis. We screened for LUTS based on four specific questions on the relevant questionnaire. We calculated GNRI according to the relevant calculation formula and included other covariates. Multivariate logistic analysis using GNRI as the principal independent variable and adjusting for other covariates were used to determine the association with LUTS, nocturia, and daytime LUTS. Results According to the responses to the questionnaire, out of 2,607 eligible participants, 471 had LUTS, 906 had nocturia, and 819 had daytime LUTS. In the unadjusted regression model, LUTS (OR = 0.93, 95% CI = 0.91-0.96, p < 0.001), nocturia (OR = 0.90, 95% CI = 0.88-0.93, p < 0.001), and daytime LUTS (OR = 0.96, 95% CI = 0.94-0.99, p = 0.002) were significantly negatively associated with GNRI. After adjustment by adding covariates, LUTS (OR = 0.97,95% CI =0.94-0.99, p = 0.026) and nocturia (OR = 0.94, 95% CI =0.91-0.93, p < 0.001) were significantly negatively associated with GNRI. Conclusion Low GNRI was associated with the development of LUTS. In the prevention and treatment of LUTS, urologists should consider the impact of nutritional status on LUTS, and interventions for nutritional status may prevent and improve LUTS.
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Affiliation(s)
- Tianyun Zheng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Yueqing Tang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Zeng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
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Feng J, Wang L, Yang X, Chen Q, Cheng X. Clinical significance of geriatric nutritional risk index in esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108323. [PMID: 38603867 DOI: 10.1016/j.ejso.2024.108323] [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: 11/24/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The geriatric nutritional risk index (GNRI) is a novel nutrition-related indicator designed to predict the risk of clinical outcomes in various cancers. The clinical significance of risk assessment, therapeutic response, and prognostic prediction of GNRI in esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant immunochemotherapy (NICT), a hot point of treatment these days, have not been documented in any research. METHODS Two hundred and twenty-four cases with ESCC who underwent radical resection after NICT were retrospectively recruited. Using the calculation formula of GNRI (1.489 × albumin (g/L) + 41.7 × current weight/ideal weight), the cases were split into two cohorts. Analysis was done on the connections between GNRI and clinical outcomes, such as clinical features, postoperative complications, and pathological complete response (pCR). Prognostic factors of overall survival (OS) and disease-free survival (DFS) were also performed. RESULTS Patients were then categorized as low (n = 139) or high (n = 85) group based on the threshold. After radical surgery, 67 patients achieved pCR (29.9%). Higher pCR rates were attained by patients in the high GNRI group (41.2% vs. 23.0%, P = 0.004). Lower GNRI patients experienced a considerably higher severe morbidity (36.7% vs. 23.5%, P = 0.040), particularly in the case of respiratory complications (28.8% vs. 14.1%, P = 0.012). Compared to high GNRI patients, lower GNRI cases had inferior 3-year OS (68.5% vs. 87.3%, P = 0.003) and DFS (64.8% vs. 81.5%, P = 0.002). It was also discovered that GNRI was a significant independent variable of both DFS [hazard ratios (HR) = 0.436, P = 0.009] and OS (HR = 0.294, P = 0.012). CONCLUSION The GNRI, based on nutrition-related indicators, was independently related to postoperative complications, pCR prediction, and prognostication in ESCC receiving NICT.
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Affiliation(s)
- Jifeng Feng
- Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
| | - Qixun Chen
- Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
| | - Xiangdong Cheng
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
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Wang T, Wang Y, Liu Q, Guo W, Zhang H, Dong L, Sun J. Association Between Geriatric Nutrition Risk Index and 90-Day Mortality in Older Adults with Chronic Obstructive Pulmonary Disease: a Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2024; 19:1197-1206. [PMID: 38831891 PMCID: PMC11146612 DOI: 10.2147/copd.s457422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Background Malnutrition adversely affects prognosis in various medical conditions, but its implications in older adults with Chronic Obstructive Pulmonary Disease (COPD) in the ICU are underexplored. The geriatric nutritional risk index (GNRI) is a novel tool for assessing malnutrition risk. This study investigates the association between GNRI and 90-day mortality in this population. Methods We selected older adults with COPD admitted to the ICU from Medical Information Mart for Intensive Care (MIMIC)-IV 2.2 database. A total of 666 patients were categorized into four groups based on their GNRI score: normal nutrition (>98), mild malnutrition (92-98), moderate malnutrition (82-91), and severe malnutrition (≤81) groups. We employed a restricted cubic spline (RCS) analysis to assess the presence of a curved relationship between them and to investigate any potential threshold saturation effect. Results In multivariate Cox regression analyses, compared with individuals had normal nutrition (GNRI in Q4 >98), the adjusted HR values for GNRI in Q3 (92-98), Q2 (82-91), and Q1 (≤81) were 1.81 (95% CI: 1.27-2.58, p=0.001), 1.23 (95% CI: 0.84-1.79, p=0.296), 2.27 (95% CI: 1.57-3.29, p<0.001), respectively. The relationship between GNRI and 90-day mortality demonstrates an L-shaped curve (p=0.016), with an approximate inflection point at 101.5. Conclusion These findings imply that GNRI is a useful prognostic tool in older adults with COPD in the ICU. An L-shaped relationship was observed between GNRI and 90-day mortality in these patients.
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Affiliation(s)
- Tingting Wang
- Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Yang Wang
- Department of Laboratory Medicine, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Qingyue Liu
- Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Wenbin Guo
- Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Hongliang Zhang
- Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Liangliang Dong
- Department of Respiratory Medicine, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
| | - Jiajun Sun
- Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong Province, 252600, People’s Republic of China
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Matsunaga T, Saito H, Osaki T, Fukuda K, Fukumoto Y, Takahashi S, Taniguchi K, Iwamoto A, Kuroda H, Katano K, Shimizu S, Shishido Y, Miyatani K, Sakamoto T, Fujiwara Y. Using the geriatric nutritional risk index to predict outcomes in older patients with remnant gastric cancer after gastrectomy: a retrospective multicenter study in Japan. Surg Today 2024:10.1007/s00595-024-02850-w. [PMID: 38652300 DOI: 10.1007/s00595-024-02850-w] [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: 02/08/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study investigated the prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing curative gastrectomy for remnant gastric cancer (RGC). METHODS This multicenter retrospective study included 105 patients with RGC of ≥ 65 years of age who underwent curative gastrectomy at 10 institutions in Japan between January 2000 and December 2016. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) were analyzed. RESULTS Receiver operating curve analyses indicated that the optimal cutoff value of the GNRI for OS was 95.4. Patients were categorized into high and low GNRI groups based on the optimal GNRI cutoff value. The GNRI was significantly correlated with body mass index (p < 0.001), amount of bleeding (p = 0.021), Clavien-Dindo grade 5 postoperative complications (p = 0.040), death caused by primary disease (p = 0.010), and death caused by other diseases (p = 0.002). The OS and DSS were significantly worse in the low GNRI group. A low GNRI and T3 or deeper tumor invasion were independent prognostic factors for OS and DSS. CONCLUSIONS The GNRI is a promising predictor of both short- and long-term outcomes in older patients with RGC.
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Affiliation(s)
- Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan.
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, 680-8517, Japan
| | - Tomohiro Osaki
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori, 680-0901, Japan
| | - Kenji Fukuda
- Department of Surgery, Sanin Rosai Hospital, Yonago, 683-8605, Japan
| | - Yoji Fukumoto
- Division of Gastroenterology, Matsue City Hospital, Matsue, 690-8509, Japan
| | - Sadamu Takahashi
- National Hospital Organization, Hamada Medical Center, Hamada, 697-8511, Japan
| | - Kenjiro Taniguchi
- Department of Surgery, Yonago Medical Center of National Hospital Organization, Yonago, 683-0006, Japan
| | - Akemi Iwamoto
- Division of Digestive Surgery, Tottori Prefectural Kousei Hospital, Kurayoshi, 682-0804, Japan
| | - Hirohiko Kuroda
- Department of Surgery, Japanese Red Cross Masuda Hospital, Masuda, 698-8501, Japan
| | - Kuniyuki Katano
- Department of Surgery, Nanbu Town National Health Insurance Saihaku Hospital, Nanbu, 683-0323, Japan
| | - Shota Shimizu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, Yonago, 683-8504, Japan
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Ito Y, Abe A, Hayashi H. Impact of preoperative haemoglobin, albumin, lymphocyte, and platelet score on oral cancer prognosis. Oral Dis 2024. [PMID: 38566263 DOI: 10.1111/odi.14950] [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: 09/06/2023] [Revised: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To evaluate the preoperative haemoglobin, albumin, lymphocyte, and platelet score as a prognostic indicator in oral squamous cell carcinoma treated by radical surgery. SUBJECTS AND METHODS Patients (83 men, 32 women; 65.80 ± 11.47 years) who underwent radical surgery between 2012 and 2022 were included. Factors affecting overall survival and disease-free survival according to the haemoglobin, albumin, lymphocyte, and platelet score were examined. Patients were categorised into low- and high-score groups using optimal cut-off values obtained from receiver operating characteristic curve analysis. RESULTS The low-score group had poorer overall and disease-free survival (p < 0.001 each). Multivariate analysis identified alcohol consumption (hazard ratio [HR], 3.83; 95% confidence interval [CI]: 1.56-9.41, p = 0.003); vascular invasion (HR, 3.97; 95% CI: 1.60-9.85, p = 0.003); and the haemoglobin, albumin, lymphocyte, and platelet score (HR, 0.39; 95% CI: 0.20-0.78, p = 0.007) as independent prognostic factors for overall survival and vascular (HR, 3.66; 95% CI: 1.79-7.50, p < 0.001) and lymphovascular (HR, 2.44; 95% CI: 1.36-4.41, p = 0.003) invasion as independent prognostic factors for disease-free survival. CONCLUSION The preoperative haemoglobin, albumin, lymphocyte, and platelet score may be a significant prognostic factor for patients with oral squamous cell carcinoma undergoing radical surgery.
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Affiliation(s)
- Yu Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
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da Costa Pereira JP, da Silva Diniz A, de Lemos MCC, Ramiro CPSP, Cabral PC. Prognostic value of the geriatric nutritional risk index and other hematological markers on long-term survival in the geriatric population. Geriatr Gerontol Int 2024; 24:312-318. [PMID: 38323744 DOI: 10.1111/ggi.14821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The prognostic value of hematological markers has not been extensively explored in the geriatric population, particularly in the presence of the frailty phenotype among hospitalized individuals. Therefore, our study aimed to assess the influence of the frailty phenotype in hospitalized geriatric individuals on hematological markers and their impact on short- and long-term outcomes. METHODS This is a secondary analysis of a prospective cohort study. This study involved hospitalized individuals who were followed during their hospitalization and for nearly 2 years after discharge. At baseline, Fried's frailty phenotype was assessed, as well as hematological markers, including neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, neutrophil-monocyte ratio, platelet-lymphocyte ratio, systemic inflammation index, prognostic nutritional index, geriatric nutritional risk index (GNRI), and C-reactive protein-albumin ratio. The phase angle derived from bioelectrical impedance analysis was likewise considered a prognostic biomarker. Our main outcomes were hospital length of stay and mortality during follow-up. RESULTS Frailty occurred in 43.2% of the population. Individuals with the frailty phenotype exhibited worse hematological markers and lower phase angle values. Low GNRI and elevated C-reactive protein-albumin ratio values were independently associated with mortality (hazard ratio = 6.88, 95% confidence interval 2.0-23.6; hazard ratio = 2.2, 95% confidence interval 1.1-4.4). Only higher values of the systemic inflammation index were independently associated with prolonged hospital stays. CONCLUSION Hematological markers may serve as a feasible tool for prognostic assessment. Individuals with the frailty phenotype and low GNRI represented a worst-case scenario. Geriatr Gerontol Int 2024; 24: 312-318.
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Affiliation(s)
- Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | - Alcides da Silva Diniz
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | - Maria Conceição Chaves de Lemos
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | | | - Poliana Coelho Cabral
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
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Liu SH, Cerri-Droz P, Loyst RA, Komatsu DE, Wang ED. Shoulder arthroscopy in elderly patients: malnutrition and early postoperative outcomes. JSES Int 2024; 8:41-46. [PMID: 38312264 PMCID: PMC10837690 DOI: 10.1016/j.jseint.2023.08.023] [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] [Indexed: 02/06/2024] Open
Abstract
Background This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple, readily available malnutrition risk index, and 30-day postoperative complications following shoulder arthroscopy. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients aged ≥65 years who underwent shoulder arthroscopy between 2015 and 2021. The study population was indexed into 3 cohorts of preoperative GNRI: normal/reference (GNRI >98), moderate malnutrition (92≤ GNRI ≤98), and severe malnutrition (GNRI <92). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications. Results Severe malnutrition was independently significantly associated with a greater likelihood of any complication (odds ratio [OR]: 11.70, 95% confidence interval [CI]: 8.58-15.94; P < .001), sepsis (OR: 26.61, 95% CI: 10.86-65.21; P < .001), septic shock (OR: 7.53, 95% CI: 1.56-36.32; P = .012), blood transfusions (OR: 25.38, 95% CI: 6.40-100.59; P < .001), pulmonary embolism (OR: 7.25, 95% CI: 1.27-41.40; P = .026), surgical site infection (OR: 22.08, 95% CI: 7.51-64.97; P < .001), nonhome discharge (OR: 15.75, 95% CI: 9.83-25.23; P < .001), readmission (OR: 2.69, 95% CI: 1.52-4.74; P < .001), unplanned reoperation (OR: 6.32, 95% CI: 2.23-17.92; P < .001), length of stay >2 days (OR: 23.66, 95% CI: 16.25-34.45; P < .001), and mortality (OR: 14.25, 95% CI: 2.89-70.40; P = .001). Conclusion GNRI-based malnutrition is strongly predictive of perioperative complications following shoulder arthroscopy in geriatric patients and has utility as an adjunctive risk stratification tool.
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Affiliation(s)
- Steven H. Liu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Patricia Cerri-Droz
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Rachel A. Loyst
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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Naiki T, Takahara K, Watanabe H, Nakane K, Sugiyama Y, Koie T, Shiroki R, Miyake H, Yasui T. The Geriatric Nutritional Risk Index Predicts Prognosis in Japanese Patients with LATITUDE High-Risk Metastatic Hormone-Sensitive Prostate Cancer: A Multi-Center Study. Cancers (Basel) 2023; 15:5333. [PMID: 38001593 PMCID: PMC10670086 DOI: 10.3390/cancers15225333] [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: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Malnutrition is associated with prognosis in cancer. The geriatric nutritional risk index (GNRI), based on the ratio of actual to ideal body weight and also serum albumin level, is a simple screening tool for assessing nutrition. We investigated the GNRI as a prognostic factor for oncological outcomes in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC) using a Japanese multicenter cohort. This study included a total of 175 patients with LATITUDE high-risk mHSPC, of whom 102 had received androgen deprivation therapy (ADT) plus upfront abiraterone acetate, and 73 had received ADT plus bicalutamide (Bica), from 14 institutions associated with the Tokai Urologic Oncology Research Seminar. Patients were classified into GNRI-low (<98) or GNRI-high (≥98) groups. The GNRI was based on the body mass index and serum albumin level. Kaplan-Meier analysis revealed that the median overall survival (OS) of a GNRI-low group (median 33.7 months; 95% confidence interval [CI]: 26.2-not reached [NR]) was significantly worse than that of a GNRI-high group (median: NR; 95% CI: NR-NR; p < 0.001). Multivariate analysis identified Bica and low GNRI (<98) as independent prognostic factors for reduced times to both castration-resistant prostate cancer and OS, and, therefore, a poor prognosis. Our findings indicate the GNRI may be a practical prognostic indicator in the evaluation of survival outcomes in patients with LATITUDE high-risk mHSPC.
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Affiliation(s)
- Taku Naiki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (Y.S.); (T.Y.)
| | - Kiyoshi Takahara
- Department of Urology, Fujita Medical University, Nagoya 470-1192, Japan; (K.T.); (R.S.)
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu 431-3125, Japan; (H.W.); (H.M.)
| | - Keita Nakane
- Department of Urology, Gifu University, Gifu 501-1112, Japan; (K.N.); (T.K.)
| | - Yosuke Sugiyama
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (Y.S.); (T.Y.)
| | - Takuya Koie
- Department of Urology, Gifu University, Gifu 501-1112, Japan; (K.N.); (T.K.)
| | - Ryoichi Shiroki
- Department of Urology, Fujita Medical University, Nagoya 470-1192, Japan; (K.T.); (R.S.)
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu 431-3125, Japan; (H.W.); (H.M.)
| | - Takahiro Yasui
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (Y.S.); (T.Y.)
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11
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Feliu J, Custodio AB, Pinto-Marín A, Higuera O, Pérez-González M, del Pino L, Ruiz-Jiménez L, Sánchez-Cabero D, Viera I, Jurado A, Espinosa E. Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy. Cancers (Basel) 2023; 15:4670. [PMID: 37760638 PMCID: PMC10526243 DOI: 10.3390/cancers15184670] [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: 07/18/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Determining the risk of grade 3-5 toxicity and early death (ED) is important to plan chemotherapy in older adult patients with cancer. Our objective was to identify factors predicting these complications at the time of treatment initiation. METHODS 234 patients aged ≥70 were subjected to a geriatric assessment and variables related to the tumor and the treatment were also collected. Logistic regression multivariable analysis was used to relate these factors with the appearance of grade 3-5 toxicity and ED. Predictive scores for both toxicity and ED were then developed. RESULTS Factors related to grade 3-5 toxicity were hemoglobin, MAX2 index, ADL, and the CONUT score. Factors related to ED were tumor stage and the GNRI score. Two predictive scores were developed using these variables. ROC curves for the prediction of toxicity and ED were 0.71 (95% CI: 0.64-0.78) and 0.73 (95% CI: 0.68-0.79), respectively. CONCLUSIONS Two simple and reliable scores were developed to predict grade 3-5 toxicity and ED in older adult patients with cancer. This may be helpful in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Belén Custodio
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alvaro Pinto-Marín
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Oliver Higuera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Miriam Pérez-González
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Laura del Pino
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Leticia Ruiz-Jiménez
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Darío Sánchez-Cabero
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Isabel Viera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Ana Jurado
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Enrique Espinosa
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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12
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Luo N, Li H, Luo Y, Hu P, Liang L, Zhang R, Zhang D, Cai D, Kang J. Prognostic significance of psoas muscle index in male hepatocellular carcinoma patients treated with immune checkpoint inhibitors and tyrosine kinase inhibitors. Hum Vaccin Immunother 2023; 19:2258567. [PMID: 37728115 PMCID: PMC10512869 DOI: 10.1080/21645515.2023.2258567] [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: 04/13/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023] Open
Abstract
Currently, the relationship between nutritional indices and the prognosis of hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) remains unclear. This study aims to investigate the prognostic value of psoas muscle index (PMI), prognostic nutritional index (PNI), body mass index (BMI), and geriatric nutritional risk index (GNRI) in HCC patients treated with ICIs combined with TKIs. A total of 124 male patients with HCC were included in this study. PNI, PMI, BMI, and GNRI were calculated at the beginning of treatment. The Cox proportional hazards model was used to analyze the effect of various variables. In the univariate analysis, PMI, PNI, GNRI, and ALB were found to impact the outcomes of the patients at different follow-up times. However, the predictive value of these nutritional indices was eliminated when established risk factors were considered. In the multivariate analysis that only included nutrition-related indicators, PMI emerged as an independent prognostic factor for 1-year treatment outcomes. The group with low PMI (≤5.5409 cm2/m2) was found to have a higher risk of death at one year and at the end of the follow-up period.
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Affiliation(s)
- Ning Luo
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hu Li
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yindeng Luo
- Department of Radiology of the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Peng Hu
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Luwen Liang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rong Zhang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Dazhi Zhang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Dachuan Cai
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Juan Kang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Rau CS, Tsai CH, Chou SE, Su WT, Hsu SY, Hsieh CH. The Addition of the Geriatric Nutritional Risk Index to the Prognostic Scoring Systems Did Not Improve Mortality Prediction in Trauma Patients in the Intensive Care Unit. Emerg Med Int 2023; 2023:3768646. [PMID: 37293272 PMCID: PMC10247323 DOI: 10.1155/2023/3768646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Background Malnutrition is prevalent among critically ill patients and has been associated with a poor prognosis. This study sought to determine whether the addition of a nutritional indicator to the various variables of prognostic scoring models can improve the prediction of mortality among trauma patients in the intensive care unit (ICU). Methods This study's cohort included 1,126 trauma patients hospitalized in the ICU between January 1, 2018, and December 31, 2021. Two nutritional indicators, the prognostic nutrition index (PNI), a calculation based on the serum albumin concentration and peripheral blood lymphocyte count, and the geriatric nutritional risk index (GNRI), a calculation based on the serum albumin concentration and the ratio of current body weight to ideal body weight, were examined for their association with the mortality outcome. The significant nutritional indicator was served as an additional variable in prognostic scoring models of the Trauma and Injury Severity Score (TRISS), the Acute Physiology and Chronic Health Evaluation (APACHE II), and the mortality prediction models (MPM II) at admission, 24, 48, and 72 h in the mortality outcome prediction. The predictive performance was determined by the area under the receiver operating characteristic curve. Results Multivariate logistic regression revealed that GNRI (OR, 0.97; 95% CI, 0.96-0.99; p=0.007), but not PNI (OR, 0.99; 95% CI, 0.97-1.02; p=0.518), was independent risk factor for mortality. However, none of these predictive scoring models showed a significant improvement in prediction when the GNRI variable is incorporated. Conclusions The addition of GNRI as a variable to the prognostic scoring models did not significantly enhance the performance of the predictors.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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14
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Li L, He J. Prognostic Role of Geriatric Nutritional Risk Index in Patients with Pancreatic Cancer: A Meta-Analysis. Nutr Cancer 2023:1-10. [PMID: 37162261 DOI: 10.1080/01635581.2023.2209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: The Geriatric Nutritional Risk Index (GNRI) is used to assess the prognosis of patients with pancreatic cancer. Therefore, this meta-analysis was conducted to evaluate the association between the GNRI and prognosis in pancreatic cancer.Methods: We performed a pooled analysis of the hazard ratios (HRs) and 95% confidence intervals (CIs) of the GNRI for survival in pancreatic cancer. Using pooled odds ratios (ORs) and 95% CIs, we investigated the association between the GNRI and clinicopathological characteristics of pancreatic cancer.Results: Six studies were included in this meta-analysis, totaling 1,513 patients. A low GNRI was significantly associated with a poorer overall survival (OS) in the pooled results (HR, 1.95; 95% CI, 1.29-2.94; p = 0.002) in pancreatic cancer. However, GNRI was not significantly associated with progression-free survival (PFS) in pancreatic cancer (HR, 1.57; 95% CI, 0.90-2.73; p = 0.114). The pooled results indicated that a low GNRI was significantly associated with tumor location of pancreas head (OR, 2.18; 95% CI, 1.45-3.29; p < 0.001).Conclusions: This meta-analysis showed that low GNRI was significantly associated with poor OS but not with poor PFS in patients with pancreatic cancer. The GNRI is a novel and effective risk factor and a potential biomarker for the prognosis of pancreatic cancer.
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Affiliation(s)
- Lili Li
- Clinical Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Junjun He
- Clinical Laboratory, Traditional Chinese Medical Hospital of Huzhou Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
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15
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Liu XY, Zhang X, Zhang Q, Ruan GT, Xie HL, Liu T, Song MM, Ge YZ, Deng L, Shi HP. Lymphocyte-C-reactive protein ratio with calf circumference could better predict survival of patients with non-metastatic cancer. Sci Rep 2023; 13:7217. [PMID: 37137949 PMCID: PMC10156854 DOI: 10.1038/s41598-023-34096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
Systemic inflammatory responses caused by tumor cells play an important role in the occurrence and development of tumors. The aim of this study was to identify biomarkers that most accurately predict prognoses in patients with non-metastatic cancer and to evaluate their clinical significance when combined with muscle markers. This study retrospectively evaluated 2,797 cancer patients diagnosed with cancer at TNM stages I, II, and III. Lymphocyte-C-reactive protein ratio (LCR) in conjunction with calf circumference (CC) were used (or chosed) after evaluating the predictive value of 13 inflammatory marker combinations and five anthropometric indicators for patient outcomes using the C-index. The Kaplan-Meier method and Cox's proportional hazards regression modeling were used to analyze the individual and combined effects of these two potential biomarkers on overall survival. This study enrolled 1,604 men (57.3%) and 1,193 women (42.7%) with a mean age of 58.75 years. Among the 13 inflammatory nutritional indicators, the LCR was the most accurate predictor of prognoses in patients with non-metastatic cancer. After multifactorial adjustment, we found that low LCR had an adverse effect on overall survival (hazard ratio [HR]: 2.50; 95% confidence interval [CI]: 2.17, 2.88; P < 0.001). Low LCR combined with low CC was also shown to be an independent risk factor for poor overall survival (HR: 2.26; 95% CI: 1.80, 2.83; P < 0.001). Compared with LCR or CC alone, the combination of the two had greater prognostic value for patients with non-metastatic cancer. The LCR can be implemented as a useful biomarker to predict prognoses in patients with non-metastatic cancer. CC is the best anthropometric indicator of muscle loss in patients with non-metastatic cancer. The combination of LCR and CC can better predict the prognosis of patients with non-metastatic cancer, and can provide important information for clinicians to formulate diagnosis and treatment plans.
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Affiliation(s)
- Xiao-Yue Liu
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xi Zhang
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, China
| | - Qi Zhang
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Guo-Tian Ruan
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Hai-Lun Xie
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Tong Liu
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Meng-Meng Song
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Yi-Zhong Ge
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Li Deng
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.
| | - Han-Ping Shi
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.
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Kato R, Miyamoto Y, Ouchi M, Ogawa K, Yoshida N, Baba H. The Geriatric Nutritional Risk Index is a prognostic marker in patients with metastatic colorectal cancer. Int J Clin Oncol 2023:10.1007/s10147-023-02338-6. [PMID: 37072628 DOI: 10.1007/s10147-023-02338-6] [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: 11/13/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The Geriatric Nutritional Risk Index (GNRI) is a nutritional index for elderly patients that is associated with prognosis in cancer patients. We investigated using the GNRI in patients with metastatic colorectal cancer to predict prognosis. METHODS This study included 419 metastatic colorectal cancer patients who received first-line chemotherapy between February 2005 and December 2020. First, we calculated pre-treatment GNRI and divided the patients into four groups according to the values (G1-G4). We evaluated patient characteristics and overall survival in the four groups. RESULTS Overall, 419 patients were included. The median follow-up was 34.4 months. Lower GNRI was positively associated with a lower grade Eastern Cooperative Oncology Group Performance Status (p = 0.009), synchronous metastases (p < 0.001), primary tumor resection prior to chemotherapy (p = 0.006), and did not undergo resection after chemotherapy (p < 0.001). Patients with low GNRI had significantly shorter overall survival than the group with high GNRI (median OS: G1 = 19.3 months [M], G2 = 30.8 M, G3 = 38 M, G4 = 39.7 M; log-rank test, p < 0.001). Multivariate Cox regression analysis showed that GNRI was an independent prognostic factor (G3: HR = 0.49, 95% CI = 0.35-0.69; G4: HR = 0.67, 95% CI = 0.48-0.93). In the subgroup analysis of overall survival, we found no interaction between clinicopathological factors and the prognostic value of GNRI. Interestingly, younger patients (< 70 years) but not older patients showed a significant difference in overall survival according to GNRI, despite being the metric being designed for elderly patients. CONCLUSION Pretreatment GNRI can be a prognostic marker for patients with mCRC who received systemic chemotherapy.
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Affiliation(s)
- Rikako Kato
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Mayuko Ouchi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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17
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Zhu L, Xia J, Shao X, Pu X, Chen J, Zhang J, Wu X, Zheng J, Wu D, Chen B. The relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage in patients with stroke: a cross-sectional study. BMC Geriatr 2023; 23:173. [PMID: 36973674 PMCID: PMC10045810 DOI: 10.1186/s12877-023-03919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Malnutrition is a common complication after stroke and may worsen neurological outcomes for patients. There are still no uniform tools for screening nutritional status for the patients with stroke. We aimed to explore the relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage for patients with stroke and assessed the predictive value of the GNRI for adverse neurological outcomes. METHODS A total of 311 patients with stroke were enrolled retrospectively. Basic information and laboratory results on admission since onset of stroke were collected. The GNRI on admission was calculated and neurological outcomes evaluated by the Barthel index at 1 month after the onset of stroke. Statistical analyses, including correlation coefficient tests, multivariate regression analyses, and receiver operating characteristic (ROC) analyses, were applied in this study. RESULTS Compared with the good outcome group, the poor outcome group showed a significantly lower GNRI on admission (P < 0.05). GNRI was associated with Barthel index (r = 0.702, P < 0.01). The GNRI was independently correlated with the Barthel index (Standardization β = 0.721, P < 0.01) and poor outcome 0.885 (95% CIs, 0.855-0.917, P < 0.01) after adjusting for covariates. Compared with no nutritional risk grades (Q4), the OR of GNRI to poor neurological outcome increased across increasing nutritional risk grades of GNRI (OR = 2.803, 95% CIs = 1.330-5.909 in Q3, 7.992, 95% CIs = 3.294-19.387 in Q2 and 14.011, 95% CIs = 3.972-49.426 in Q1, respectively, P for trend < 0.001). The area under ROC curves (AUC) of the GNRI was 0.804, which was larger than that of the NIHSS, BMI, or Albumin (P < 0.01), with an optimal cut-off value of 97.69, sensitivity of 69.51% and specificity of 77.27%. Combined GNRI with NIHSS gained the largest AUC among all the variables (all P < 0.05), with an AUC of 0.855, sensitivity of 84.75 and specificity of 72.73%. CONCLUSIONS For patients with stroke, higher nutritional risk grades at baseline indicated worse neurological function at the convalescence stage. Compared with NIHSS, BMI, and Albumin, GNRI was a competitive indicator for the risk of poor neurological outcome. The predictive property of GNRI for adverse neurological outcomes might be more powerful when combined with NIHSS.
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Affiliation(s)
- Lielie Zhu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jianning Xia
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xiangzhi Shao
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xinyu Pu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jiajun Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xinming Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Dengchong Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Bing Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China.
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The Geriatric Nutritional Risk Index predicts sarcopenia in patients with cirrhosis. Sci Rep 2023; 13:3888. [PMID: 36890183 PMCID: PMC9995649 DOI: 10.1038/s41598-023-31065-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Patients with cirrhosis are at high risk for sarcopenia and malnutrition, which are associated with reduced quality of life and increased mortality. We investigated the relationship between the Geriatric Nutritional Risk Index (GNRI) and sarcopenia/gait speed and assessed the usefulness of the GNRI for predicting sarcopenia in patients with cirrhosis. We evaluated 202 patients with cirrhosis and divided them into three groups based on baseline GNRI values: low (L)-GNRI (< 94.0, n = 49), intermediate (I)-GNRI (between 94.0 and 109.5, n = 103), and high (H)-GNRI groups (> 109.5, n = 50). Sarcopenia was diagnosed according to the criteria of the Japan Society of Hepatology. The prevalence of sarcopenia and slow gait speed was the lowest in the H-GNRI group (8.0% and 26.0%, respectively) and the highest in the L-GNRI group (49.0% and 44.9%, respectively). They increased stepwise with a decline in the GNRI group (p < 0.001 and p = 0.05, respectively). The GNRI values were significantly and positively correlated with handgrip strength, skeletal muscle mass index, and gait speed. Multivariate analysis identified lower GNRI as an independent risk factor for sarcopenia. The optimal cutoff value of the GNRI for predicting sarcopenia was 102.1 (sensitivity/specificity, 0.768/0.630). The GNRI was significantly associated with sarcopenia and physical performance and could be a helpful screening tool for predicting sarcopenia in patients with cirrhosis.
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Lidoriki I, Frountzas M, Mela E, Papaconstantinou D, Vailas M, Sotiropoulou M, Koliakos N, Toutouzas KG, Schizas D. The Prognostic Role of GLIM Criteria in Postoperative Outcomes after Upper Gastrointestinal Cancer Surgery: A Meta-Analysis of Observational Studies. Nutr Cancer 2023; 75:640-651. [PMID: 36394396 DOI: 10.1080/01635581.2022.2146144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oncologic patients often suffer from malnutrition, which might negatively affect treatment outcomes. Global Leadership Initiative on Malnutrition (GLIM)-based malnutrition is associated with short- and long-term outcomes in cancer patients. The aim of the current meta-analysis was to determine the impact of GLIM-defined malnutrition on postoperative complications and survival in esophageal and gastric cancer patients. A systematic search was conducted to identify studies published until February 2022 that assessed the association between GLIM criteria and short- and long-term outcomes in esophageal and gastric cancer patients. We included seven observational studies reporting on a total of 3662 patients with esophageal and gastric cancer. GLIM-defined malnutrition was associated with increased overall complications (pooled HR 2.58, 95% CI 1.45-4.59, p = 0.001). Malnutrition was significantly associated with decreased overall survival (pooled HR 1.63, 95% CI 1.18-1.84, p = 0.003) as well as with decreased disease-free survival (pooled HR 1.78, 95% CI 1.36-2.33, p < 0.0001). GLIM-based malnutrition was associated with an increased risk for developing postoperative complications and impaired survival of esophageal and gastric cancer patients. Our findings support the use of GLIM criteria in clinical practice as a relatively simple and reliable tool for assessing the nutritional status of oncologic patients.
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Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- First Postdoctoral Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Evgenia Mela
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Sotiropoulou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Koliakos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos G Toutouzas
- First Postdoctoral Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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20
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Matsui R, Rifu K, Watanabe J, Inaki N, Fukunaga T. Impact of malnutrition as defined by the GLIM criteria on treatment outcomes in patients with cancer: A systematic review and meta-analysis. Clin Nutr 2023; 42:615-624. [PMID: 36931162 DOI: 10.1016/j.clnu.2023.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND & AIMS Malnutrition has been reported to lead to poor postoperative outcomes. The Global Leadership Initiative on Malnutrition (GLIM) criteria were published in 2019 as a global consensus on the criteria for diagnosing malnutrition. However, the relationship between GLIM-defined malnutrition and treatment outcomes in patients with cancer has not been fully investigated. Therefore, this study aimed to clarify the impact of GLIM-defined malnutrition on the treatment outcomes of patients with cancer. METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov and identified observational studies published from inception to January 17, 2022. We conducted a systematic review and random-effects meta-analysis studies that included patients with cancer aged >18 years who received any kind of treatment and whose nutritional status was assessed using GLIM criteria. We independently assessed the risk of bias and quality of evidence using Quality In Prognosis Studies and Grading of Recommendations, Assessment, Development, and Evaluation approach. The primary outcomes were overall survival (OS) and postoperative complications. Hazard ratios and 95% confidence intervals (CIs) for OS and relative risk ratios and 95% CIs for postoperative complications were pooled. The protocol was published by PROSPERO (CRD42022304004). RESULTS Of 67 studies after screening, ten studies (n = 11,700) reported the impact of GLIM-defined malnutrition on postoperative outcomes. Compared with no malnutrition, GLIM-defined malnutrition may worsen OS (hazard ratio, 1.56; 95% CI, 1.38-1.75; I2 = 37%) and increase postoperative complications (relative risk ratio, 1.82; 95% CI, 1.28-2.60; I2 = 87%). The risk of bias in each study was either moderate or high. The certainty of the evidence was low because of publication bias and a moderate or high risk of bias. CONCLUSIONS GLIM-defined malnutrition may worsen OS and increase the risk of postoperative complications in patients with cancer undergoing treatment. Further studies are needed to confirm these findings and mitigate this risk.
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Affiliation(s)
- Ryota Matsui
- Department of Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu City, Chiba 279-0021, Japan; Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan; Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Kazuma Rifu
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan.
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan; Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan.
| | - Noriyuki Inaki
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan; Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Tetsu Fukunaga
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.
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Gan Y, Li J, Wu J, Zhang R, Han Q, Li Z, Yang Q. Association between geriatric nutritional risk index and pathological phenotypes of IgA nephropathy. PeerJ 2023; 11:e14791. [PMID: 36815992 PMCID: PMC9933742 DOI: 10.7717/peerj.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
Background IgA nephropathy (IgAN) is an immune disease related to oxidative stress and inflammation. It is the most common type of glomerulonephritis in the world and is the cause of chronic kidney disease and end-stage renal disease (ESRD). The Geriatric Nutritional Risk Index (GNRI) is a practical and uncomplicated method to assess the risk of morbidity and mortality, but its ability to assess IgAN is still unclear. Here, we evaluated the association between the GNRI and clinical and histologic findings of IgAN. Methods In a cross-sectional study, we included 348 biopsy-verified IgAN patients. The Oxford classification was used to analyze the pathological characteristics of the included patients. Based on previous studies, the participants were divided into two groups using a cutoff value of 92. Differences in clinicopathological indices between the two groups were compared. The correlation between the GNRI and the indicators was evaluated by using a bivariate correlation analysis. A binary logistic regression analysis was conducted to determine the factors associated with the crescent lesions in IgAN. Results In this study, 138 out of 348 patients (39.7%) had low GNRI scores (GNRI < 92). Patients in the low GNRI group tended to have a significantly lower body mass index; lower hemoglobin, serum albumin, serum IgG, and serum C3 levels; and higher 24-h proteinuria. The proportions of females, Oxford M1 and Oxford C1/2 were higher in the low GNRI group. The GNRI was positively correlated with body mass index (r = 0.57, P < 0.001), hemoglobin (r = 0.35, P < 0.001), serum albumin (r = 0.83, P < 0.001), serum IgG (r = 0.32, P < 0.001), and serum C3 (r = 0.26, P < 0.001) and negatively correlated with 24-h proteinuria (r = -0.36, P < 0.001) and the proportion of crescents (r = -0.24, P < 0.001). The GNRI scores and serum IgG levels were considered independent factors influencing the crescent lesions in IgAN. Conclusions The GNRI can reflect the severity of clinical and histologic phenotypes in IgAN patients. Lower GNRI and serum IgG levels may suggest an increased risk of crescent lesions and are potential markers for disease monitoring in IgAN.
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22
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Shiroma K, Tanabe H, Takiguchi Y, Yamaguchi M, Sato M, Saito H, Tanaka K, Masuzaki H, Kazama JJ, Shimabukuro M. A nutritional assessment tool, GNRI, predicts sarcopenia and its components in type 2 diabetes mellitus: A Japanese cross-sectional study. Front Nutr 2023; 10:1087471. [PMID: 36819693 PMCID: PMC9928854 DOI: 10.3389/fnut.2023.1087471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/02/2023] [Indexed: 02/04/2023] Open
Abstract
Background There are few reports evaluating the relationship between undernutrition and the risk of sarcopenia in type 2 diabetes mellitus (T2DM) patients. Objective We investigated whether undernutritional status assessed by the geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) were associated with the diagnosis of sarcopenia. Methods This was a cross-sectional study of Japanese individuals with T2DM. Univariate or multivariate logistic regression analysis was performed to assess the association of albumin, GNRI, and CONUT with the diagnosis of sarcopenia. The optimal cut-off values were determined by the receiver operating characteristic (ROC) curve to diagnose sarcopenia. Results In 479 individuals with T2DM, the median age was 71 years [IQR 62, 77], including 264 (55.1%) men. The median duration of diabetes was 17 [11, 23] years. The prevalence of sarcopenia was 41 (8.6%) in all, 21/264 (8.0%) in men, and 20/215 (9.3%) in women. AUCs were ordered from largest to smallest as follows: GNRI > albumin > CONUT. The cut-off values of GNRI were associated with a diagnosis of sarcopenia in multiple logistic regression analysis (odds ratio 9.91, 95% confidential interval 5.72-17.2), P < 0.001. The superiority of GNRI as compared to albumin and CONUT for detecting sarcopenia was also observed in the subclasses of men, women, body mass index (BMI) < 22, and BMI ≥ 22. Conclusions Results showed that GNRI shows a superior diagnostic power in the diagnosis of sarcopenia. Additionally, its optimal cut-off points were useful overall or in the subclasses. Future large and prospective studies will be required to confirm the utility of the GNRI cut-off for undernutrition individuals at risk for sarcopenia.
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Affiliation(s)
- Kaori Shiroma
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan,Department of Health and Nutrition, Faculty of Health and Nutrition, Okinawa University, Okinawa, Japan
| | - Hayato Tanabe
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshinori Takiguchi
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mizuki Yamaguchi
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masahiro Sato
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Haruka Saito
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes, and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), University of the Ryukyus, Okinawa, Japan
| | - Junichiro J. Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan,*Correspondence: Michio Shimabukuro ✉
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Lu S, Li X, Li X, Zhang Q, Wang Y, Peng R, Fu W, Wang H. The preoperative geriatric nutritional risk index predicts long-term prognosis in elderly locally advanced rectal cancer patients: a two-center retrospective cohort study. Aging Clin Exp Res 2023; 35:311-321. [PMID: 36399323 DOI: 10.1007/s40520-022-02297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective is to explore the value of preoperative geriatric nutritional risk index (GNRI) in evaluating long-term prognosis in elderly locally advanced rectal cancer (LARC) patients who accepted neoadjuvant chemoradiotherapy (NCRT) and to compare GNRI with established nutritional markers, including prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score. METHODS Preoperative GNRI was retrospectively assessed in 172 LARC patients aged ≥ 60 years who underwent radical resection after NCRT at two centers. Optimal cutoff value of GNRI was determined by X-tile program. The association of GNRI with clinicopathological parameters and nutritional markers was analyzed. The survival ability of markers was evaluated using time-dependent receiver-operating characteristic (ROC) curve analysis. Finally, survival analysis was performed using Kaplan-Meier and Cox regression analysis. RESULTS GNRI was highly correlated with nutritional markers. An optimal cutoff value for the GNRI was 96. In the time-dependent ROC curve, GNRI demonstrated a stable predictive ability for both disease-free survival (DFS) and overall survival (OS). Multivariate analysis showed that GNRI was the only nutritional marker that independently predicted DFS (HR 2.457, 95% CI 1.066-5.665, P = 0.035) and OS (HR 9.002, 95% CI 3.100-26.146, P < 0.001). As an additional benefit, GNRI was able to stratify survival in subgroups of ypTNM and tumor response. CONCLUSION Preoperative GNRI is a promising predictor of long-term survival for elderly LARC patients undergoing NCRT, superior to the established nutritional markers.
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Affiliation(s)
- Siyi Lu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Xianan Li
- Department of Radiation Oncology, Peking University People's Hospital, Beijing, 100044, China
| | - Xuemin Li
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Qiuxiang Zhang
- Department of Clinical Nutrition, Peking University Third Hospital, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Ran Peng
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Fu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
| | - Hao Wang
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
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Wu Q, Ye F. Prognostic impact of geriatric nutritional risk index on patients with urological cancers: A meta-analysis. Front Oncol 2023; 12:1077792. [PMID: 36713504 PMCID: PMC9875083 DOI: 10.3389/fonc.2022.1077792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background Despite previous research examining the predictive value of the geriatric nutritional risk index (GNRI) in individuals with urological cancers (UCs), results have been conflicting. This study aimed to comprehensively explore the potential link between GNRI and the prognosis of UCs using a meta-analysis. Methods The Cochrane Library, PubMed, Embase, and Web of Science databases were systematically and exhaustively searched. We estimated the prognostic importance of the GNRI in patients with UCs by calculating the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) on survival outcomes. Publication bias was identified using Egger's test and Begg's funnel plot. Results Eight trials with 6,792 patients were included in our meta-analysis. Patients with UCs who had a lower GNRI before treatment had a higher risk of experiencing worse overall survival (HR = 2.62, 95% CI = 1.69-4.09, p < 0.001), recurrence-free survival/progression-free survival (HR = 1.77, 95% CI = 1.51-2.08, p < 0.001), and cancer-specific survival (HR = 2.32, 95% CI = 1.28-4.20, p = 0.006). Moreover, the subgroup analysis did not change the predictive significance of the GNRI in individuals with UCs. Neither Egger's nor Begg's test indicated substantial bias in this analysis. Conclusion As a result of our meta-analysis, we found that a low GNRI strongly predicts poor prognosis for patients with UCs. A lower pretreatment GNRI indicates poor survival outcomes in UCs.
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Affiliation(s)
- Quan Wu
- Clinical Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Fagen Ye
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China,*Correspondence: Fagen Ye,
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Zhu Q, Zhao Q, Ping P, Zhang Q, Gong L, Feng L, Zhao Y, Fu S. Relationships Between Hair Chemical Elements and Nutritional Status in Oldest-Old and Centenarian Populations. J Multidiscip Healthc 2023; 16:1171-1178. [PMID: 37143478 PMCID: PMC10153404 DOI: 10.2147/jmdh.s401523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023] Open
Abstract
Background Hair chemical elements reflect physical condition over time. Collection, transporting, and storing hair is more convenient than handling blood. Hair elements show higher levels for a long time, which allows for more accurate and sensitive results than using blood. Studies explored the relationships between elements and age, without full consideration of nutritional status, in older people. This study explored the relationships between hair chemical elements and Geriatric Nutritional Risk Index (GNRI) in oldest-old and centenarian populations to provide an updated reference for nutritional evaluation of older people. Methods A total of 152 participants over 80 years old underwent home interviews and physical examinations. An inductively coupled plasma mass spectrometer was used to detect hair chemical elements. Results Women accounted for 77.0% of participants. Women had lower levels of zinc, and higher levels of selenium, manganese, lead, iron, and copper than men (P<0.05 for all). Ninety-two participants formed the 80-99 year group, and 60 participants formed the 100+ year group. Centenarians had lower levels of selenium, lead, iron, and copper than those aged 80-99 years (P<0.05 for all). Hair selenium levels were positively associated with GNRI (odds ratio: 11.55, 95% confidence interval: 3.42-19.68, P < 0.05) based on a multivariate linear regression analysis. Other chemical elements had no significant associations with GNRI based on a multivariate linear regression analysis. Conclusion Chemical elements and nutrient status were altered based on age and gender, and an association existed between hair selenium and nutritional status in older people. Chemical elements may influence and indicate nutritional status in older people.
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Affiliation(s)
- Qiao Zhu
- Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
| | - Qingkai Zhao
- Department of Health Medicine, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
| | - Ping Ping
- General Station for Drug Instrument Supervision and Control, Joint Logistic Support Force of Chinese People’s Liberation Army, Beijing, People’s Republic of China
| | - Qian Zhang
- Department of Neurology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
| | - Li Gong
- Department of Pathology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
- Yali Zhao, Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, 572013, People’s Republic of China, Email
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, People’s Republic of China
- Department of Geriatric Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
- Correspondence: Shihui Fu, Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, 572013, People’s Republic of China, Email
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Yamaura T, Arizumi F, Maruo K, Kishima K, Yoshie N, Kusukawa T, Imamura F, Tachibana T. The Impact of Controlling Nutritional Status (CONUT) score on functional prognosis in hospitalized elderly patients with acute osteoporotic vertebral fractures. BMC Geriatr 2022; 22:1002. [PMID: 36577983 PMCID: PMC9795616 DOI: 10.1186/s12877-022-03708-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nutritional status, which is associated with osteoporosis and muscle weakness is considered an important factor in the management of acute osteoporotic vertebral fracture (AOVF). However, few reports have investigated the nutritional status of hospitalized patients with AOVF and the impact of malnutrition on their functional prognosis. This study aimed to evaluate the nutritional status of hospitalized elderly patients with AOVF using the Controlling Nutritional Status (CONUT) score and to determine the usefulness of the CONUT score in predicting their functional prognosis. METHODS The CONUT score on admission was retrospectively calculated for 134 hospitalized elderly patients (mean age 83 ± 7.6 years, 66% female) with AOVF who received conservative treatment between 2017 and 2020. Functional outcome was assessed by comparing ambulatory ability before the onset of AOVF and upon discharge. Patients were divided into two groups: CONUT-high ( ≥ 4) and CONUT-low ( ≤ 3), according to receiver operating characteristic (ROC) analysis to predict decline in ambulatory ability upon discharge. Logistic regression analysis was performed to obtain odds ratios (OR) and 95% confidence intervals (CI) of the relationships between the nutritional status and ambulatory ability. The discriminative power of the CONUT score was then compared with other nutritional assessment tools such as the Geriatric Nutritional Risk Index (GNRI) and prognostic nutritional index (PNI) by ROC analysis. RESULTS 81% of hospitalized patients with an AOVF were malnourished at the time of admission. The CONUT-high group had a significantly higher rate of decline in ambulatory ability (P < 0.001) than the CONUT-low group. Logistic regression analysis revealed the CONUT score ( ≥ 4) as an independent risk factor for a decline in ambulatory ability (OR 3.44, 95% CI 1.61-7.37, P = 0.0014). ROC analysis showed that the area under the curve (AUC) for the CONUT score (AUC = 0.724) was significantly greater than that for the GNRI (AUC = 0.624, P = 0.021) and PNI (AUC = 0.636, P = 0.0008). CONCLUSIONS This study showed that 81% of hospitalized elderly patients with AOVFs were malnourished and that the CONUT score was a useful predictive factor of functional prognosis.
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Affiliation(s)
- Tetsuto Yamaura
- Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan ,grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Fumihiro Arizumi
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Keishi Maruo
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Kazuya Kishima
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Norichika Yoshie
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Tomoyuki Kusukawa
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Fumiaki Imamura
- Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan
| | - Toshiya Tachibana
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
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Perioperative Decrease in Tongue Pressure is an Intervenable Predictor of Aspiration After Esophagectomy. Dysphagia 2022:10.1007/s00455-022-10541-2. [DOI: 10.1007/s00455-022-10541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
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An S, Han GY, Eo W, Kim DH, Lee S. Comparison of the geriatric nutritional risk index and the prognostic nutritional index in determining survival outcome in patients with non-small cell lung cancer undergoing surgical resection: A cohort study. Medicine (Baltimore) 2022; 101:e31591. [PMID: 36397370 PMCID: PMC9666186 DOI: 10.1097/md.0000000000031591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To assess the clinical feasibility of the geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) as determinants of survival in patients with stage I to III non-small cell lung cancer (NSCLC). This retrospective study included patients with stage I to III NSCLC from all age groups. Hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) were calculated using the Cox regression analysis. The concordance index (C-index) of the models was evaluated following the establishment of the prognostic models for survival. The median patient age was 69 years, and 64.6% of the patients were male. In total, 172 (65.4%) patients were classified as having stage I disease, 52 (19.8%) as stage II disease, and 39 (14.8%) as stage III disease. Using multivariate Cox regression analysis, the HRs of GNRI for OS, CSS, and RFS were 0.37 (P = .003), 0.47 (P = .041), and 0.38 (P < .001), respectively. However, the HRs of the PNI for survival outcomes were not statistically significant. Overall, age, sex, tumor-node-metastasis (TNM) stage, pleural invasion (PI), and GNRI were significant determinants of OS and constituted the OS model (concordance index [C-index], 0.824). In addition, age, TNM stage, PI, and GNRI were significant determinants of CSS and constituted the CSS model (C-index, 0.828). Finally, TNM stage, PI, lymphatic invasion, and GNRI were significant determinants of RFS and constituted the RFS model (C-index, 0.783). Our study showed that GNRI, but not PNI, was a predictor of OS, CSS, and RFS in patients with stage I-III NSCLC across all age groups. Excellent discriminant power was observed for OS, CSS, and RFS models.
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Affiliation(s)
- Soomin An
- Department of Nursing, Dongyang University, Gyeongbuk, Republic of Korea
| | - Ga Young Han
- Department of Music, Chang Shin University, Changwon, Republic of Korea
| | - Wankyu Eo
- College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- *Correspondence: Wankyu Eo, Department of Internal Medicine, College of Medicine, Kyung Hee University, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea (e-mail: )
| | - Dae Hyun Kim
- Department of Thoracic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sookyung Lee
- Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Hu J, Chen T, Wang Z, Chen X, Lin K, Zhang G, Wu J. Geriatric Nutritional Risk Index and the Prognosis of Patients with Stroke: A Meta-Analysis. Horm Metab Res 2022; 54:736-746. [PMID: 36070747 DOI: 10.1055/a-1886-4276] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Malnutrition evidenced by low geriatric nutritional risk index (GNRI) has been suggested as a potential predictor of poor prognosis of patients with various clinical conditions. We performed a meta-analysis to systematically assess the association between GNRI and the prognosis of patients after stroke. Cohort studies were identified by search of PubMed, Embase, Cochrane's Library and Web of Science databases from inception to March 25, 2022, according to the aim of the meta-analysis. A random-effect model incorporating the potential between-study heterogeneity was used to pool the results. Eight cohort studies with 13573 patients with stroke contributed to the meta-analysis. Pooled results showed that malnutrition as evidenced by low GNRI was independently associated with a higher risk of poor functional outcome [risk ratio (RR): 1.54, 95% confidence interval (CI): 1.19 to 1.98, p<0.001; I2=69%] and an increased incidence of all-cause mortality (RR: 1.82, 95% CI: 1.35 to 2.47, p<0.001; I2=74%). Sensitivity analyses showed consistent results in patients with ischemic stroke, and in prospective cohort studies. Subgroup analyses showed that the associations were not significant for patients with GNRI-defined mild malnutrition (p=0.18 and 0.20 for functional and mortality outcomes, respectively), but significant for patients with moderate-severe malnutrition (both p<0.001). Difference in follow-up durations did not significantly affect the associations (p for subgroup difference=0.75 and 0.70, respectively). In conclusion, a low GNRI is associated with poor functional and survival outcomes in patients after stroke.
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Affiliation(s)
- Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ting Chen
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Ziyue Wang
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xuhui Chen
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Kaihua Lin
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Guogao Zhang
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Wu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
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Güç ZG, Alacacıoğlu A, Kalender ME, Oflazoğlu U, Ünal S, Yıldız Y, Salman T, Küçükzeybek Y, Tarhan MO. HALP score and GNRI: Simple and easily accessible indexes for predicting prognosis in advanced stage NSCLC patients. The İzmir oncology group (IZOG) study. Front Nutr 2022; 9:905292. [PMID: 36061883 PMCID: PMC9437940 DOI: 10.3389/fnut.2022.905292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022] Open
Abstract
ObjectiveThe Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score and the Geriatric Nutrition Risk Index (GNRI) are used as prognostic factors in different types of cancers. In this study we analyzed the prognostic value of the HALP Score and the GNRI calculated prior to first-line treatment in patients diagnosed with de novo metastatic non-small cell lung cancer (mNSCLC).Materials and methodsDe novo mNSCLC patients were retrospectively evaluated from January 2016 to December 2019. Patients with Driver’s mutation, severe comorbidities, active infection, or insufficient organ function, and those receiving anti-inflammatory treatment were excluded from the study. Optimal cut-off points for the HALP score and the GNRI were calculated with the receiver operating characteristic (ROC) curve analysis. Predictive factors for overall survival (OS) were assessed with univariate and multivariate Cox proportional hazard analyses, and OS was studied with the Kaplan–Meier analysis.ResultsThe study included 401 patients in total. In the ROC curve analysis, the cut-off points were found 23.24 (AUC = 0.928; 95% CI: 0.901–0.955, p < 0.001) for HALP, and 53.60 (AUC = 0.932; 95% CI: 0.908–0.955, p < 0.001) for GNRI. Groups with lower HALP scores and lower GNRI had significantly shorter OS compared to those with higher HALP scores and GNRIs. Univariate analysis showed that male gender, smoking, high ECOG score, low HALP score and low GNRI were associated with worse survival rates. Multivariate analysis showed that low HALP score (HR = 2.988, 95% CI: 2.065–4.324, p < 0.001); low GNRI score (HR = 2.901, 95% CI: 2.045–4.114, p < 0.001) and smoking history (HR = 1.447, 95% CI: 1.046–2.001, p = 0.025) were independent factors associated with worse OS rates.ConclusionOur study showed the HALP score and the GNRI to be of prognostic value as simple, cost-effective, and useful markers that predict OS in de novo mNSCLC patients.
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Affiliation(s)
- Zeynep Gülsüm Güç
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
- *Correspondence: Zeynep Gülsüm Güç,
| | - Ahmet Alacacıoğlu
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mehmet Eren Kalender
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Utku Oflazoğlu
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Sinan Ünal
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Yaşar Yıldız
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Tarık Salman
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Yüksel Küçükzeybek
- Department of Medical Oncology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mustafa Oktay Tarhan
- Department of Medical Oncology, Institute of Oncology, Dokuz Eylül University, İzmir, Turkey
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Sun XY, Lin Y, Guo W, Yin XM. Prognostic Value of the Geriatric Nutritional Risk Index in Patients with Non-Small Cell Lung Cancer: A Meta-Analysis. Nutr Cancer 2022; 74:3623-3633. [PMID: 35838018 DOI: 10.1080/01635581.2022.2096244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to quantitatively identify the prognostic and clinicopathological value of the geriatric nutritional risk index (GNRI) in non-small cell lung cancer (NSCLC) through a meta-analysis. The electronic databases PubMed, Web of Science, Embase, and Cochrane Library were thoroughly searched from inception to December 14, 2021. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of GNRI. Odds ratios (ORs) and 95%CIs were combined to estimate the clinicopathological significance of the GNRI in NSCLC. Seven studies with 2,023 patients were included in the meta-analysis. A low GNRI score was significantly associated with poor overall survival (OS) (HR = 2.01, 95%CI = 1.65-2.44, p < 0.001) and worse progression-free survival (PFS), recurrence-free survival (RFS), and cancer-specific survival (CSS) (HR = 1.81, 95%CI = 1.48-2.22, p < 0.001) in NSCLC. Furthermore, a low GNRI score was significantly associated with the histological type of non-adenocarcinoma (OR= 1.55, 95%CI = 1.19-2.03, p = 0.001) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (OR= 2.81, 95%CI= 1.49-5.32, p = 0.001). A low GNRI score is a significant and effective prognostic marker for poor survival outcomes in patients with NSCLC. In addition, low GNRI score was correlated with higher ECOG PS scores.
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Affiliation(s)
- Xin-Yu Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yu Lin
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Wei Guo
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, Hebei, China
| | - Xiao-Ming Yin
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, Hebei, China
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Sakamoto T, Makinoya M, Sunaguchi T, Goto K, Morimoto M, Murakami Y, Miyatani K, Hanaki T, Shishido Y, Kihara K, Matsunaga T, Yamamoto M, Tokuyasu N, Fujiwara Y. Geriatric nutritional risk index as a prognostic factor in patients with recurrent pancreatic cancer. PLoS One 2022; 17:e0271073. [PMID: 35797279 PMCID: PMC9262175 DOI: 10.1371/journal.pone.0271073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to investigate the prognostic significance of geriatric nutritional risk index (GNRI) at the time of recurrence in patients with recurrent pancreatic cancer, and the relationship between GNRI and skeletal muscle mass for survival outcomes after recurrence. This study enrolled 77 patients who developed postoperative recurrence. The skeletal muscle mass index (SMI) was used in this study. The patients were divided into a high-GNRI group (n = 36) and a low-GNRI group (n = 41) for the GNRI, and were divided into a high-SMI group (n = 38) and a low-SMI group (n = 39) for SMI. The 2-year post-recurrence overall survival of patients in the high-GNRI group was significantly longer than that of patients in the low-GNRI group (P = 0.001). No significant difference for the 2-year post-recurrence OS curves between the high-SMI group and the low-SMI group was observed (P = 0.125). Upon stratifying the patients with high GNRI or low GNRI according to SMI, There was no significant difference in the 2-year post-recurrence OS curves between the patients with both high GNRI and high SMI and the patients with high GNRI and low SMI (P = 0.399). Similarly, There was no significant difference in the 2-year post-recurrence OS curves between the patients with low GNRI and high SMI and the patients with both low GNRI and low SMI (P = 0.256). Multivariate analysis revealed that the GNRI at the time of recurrence was an independent prognostic risk factor in patients with recurrent pancreatic cancer (P = 0.019). The GNRI at the time of recurrence is useful for predicting the prognosis in patients with recurrence pancreatic cancer. Skeletal muscle mass at the time of recurrence is not contributed to predict post-recurrence survival of patients with recurrent pancreatic cancer.
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Affiliation(s)
- Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Masahiro Makinoya
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Teppei Sunaguchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Keisuke Goto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Masaki Morimoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori prefecture, Japan
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Zhao H, Xu L, Tang P, Guo R. Geriatric Nutritional Risk Index and Survival of Patients With Colorectal Cancer: A Meta-Analysis. Front Oncol 2022; 12:906711. [PMID: 35847869 PMCID: PMC9282875 DOI: 10.3389/fonc.2022.906711] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Geriatric nutritional risk index (GNRI) is an indicator of nutritional status derived by serum albumin level and ideal body weight, which has been proposed as a predictor of prognosis for elderly population with various clinical conditions. The objective of the meta-analysis was to comprehensively evaluate the association between baseline GNRI and survival of patients with colorectal cancer (CRC). Methods Cohort studies were identified by search of PubMed, Embase, and Web of Science databases from inception to January 05, 2022 according to the aim of the meta-analysis. A random-effect model incorporating the potential between-study heterogeneity was adopted to pool the results. Results Nine studies including 3658 patients with CRC contributed to the meta-analysis. Results showed that CRC patients with lower GNRI at baseline had worse overall survival (OS, hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.78-3.23, p<0.001; I2 = 60%) and progression-free survival (PFS, HR 1.77, 95% CI 1.38-2.26, p<0.001; I2 = 33%). The results were consistent in sensitivity analyses limited to elderly patients (HR for OS 2.25, p<0.001; HR for PFS 1.65, p=0.003). Subgroup analyses showed consistent results in patents with different cancer stages, and in studies with median follow-up < and ≥ 5 years (p for subgroup effects all < 0.05). Conclusion A lower GNRI at baseline may be independent associated with poor survival outcomes of patients with CRC. Evaluating the nutritional status using GNRI may be important for risk stratification of patients with CRC.
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Affiliation(s)
- Haiming Zhao
- Department of Gastroenterology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
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Güç ZG, Altay C, Özgül HA, Ellidokuz H, Yavuzşen T. GNRI And Conut Scores: Simple Predictors of Sarcopenia in Metastatic Colorectal Cancer Patients. Support Care Cancer 2022; 30:7845-7852. [PMID: 35716261 DOI: 10.1007/s00520-022-07218-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the correlation between sarcopenia and inflammation- and nutrition-based markers in metastatic colorectal cancer (mCRC) patients. MATERIALS AND METHODS Age, body mass index (BMI), neutrophil/lymphocyte ratio (NLR), modified Glasgow prognostic score (mGPS), prognostic nutrition index (PNI), cachexia index (CIn), skeletal muscle index (SMI), controlling nutritional status (CONUT) score, and geriatric nutritional risk index (GNRI) were evaluated in 185 patients. Ideal cut-off values for the GNRI score were determined with the ROC curve analysis, and the patients were divided into two groups as low and high GNRI. Sarcopenia was diagnosed using CT scanning, the gold standard method. Univariate and multivariate Cox proportional hazard analyses were done based on the above-listed parameters to assess the correlation between sarcopenia and changes in immuno-nutrition and inflammatory response. Kaplan-Meier analysis was also done to evaluate survival. RESULTS Univariate analysis of the 185 patients based on the EGWSOP 2018 threshold values showed correlation between the presence of sarcopenia and male gender, diagnosed colon cancer, history of metastasectomy, BMI < 24, high mGPS score, PNI score ≥ 45, high CONUT score, and low GNRI score (p < 0.05). In multivariate analysis, low GNRI (HR: 2.40; 95% CI: 1.03-5.544; p = 0.040), and high-CONUT scores (HR: 2.01; 95% CI: 1.06-3.73; p = 0.029) were identified as independent prognostic factors for the presence of sarcopenia. CONCLUSION GNRI and CONUT scores are elementary and practical predictors for sarcopenia, a condition which is associated with poor outcomes in mCRC patients.
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Affiliation(s)
- Zeynep Gülsüm Güç
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | | | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Tuğba Yavuzşen
- Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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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: 6] [Impact Index Per Article: 3.0] [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.
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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
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Ito Y, Abe A, Hayashi H, Momokita M, Furuta H. Prognostic impact of preoperative Geriatric Nutritional Risk Index in oral squamous cell carcinoma. Oral Dis 2022. [PMID: 35582815 DOI: 10.1111/odi.14255] [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: 01/26/2022] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the prognostic impact of preoperative Geriatric Nutritional Risk Index (GNRI) values in older adults undergoing radical surgery for oral squamous cell carcinoma (OSCC). SUBJECTS AND METHODS This retrospective study included 61 patients ≥ 65 years old with OSCC (43 men, 18 women; age: 72.1±5.4 years) who underwent radical surgery between 2013 and 2020. Factors influencing overall survival (OS) and disease-free survival (DFS) were examined. RESULTS Receiver operating characteristic curve analysis indicated that the optimal GNRI value for classifying patients into low-GNRI (<93.7; OS: n=19 [31.1%], DFS: n=42 [68.9%]) and high-GNRI groups (≥93.7; OS, n=19 [31.1%]; DFS, n=42 [68.9%]) was 93.7. OS and DFS rates were significantly lower in the low-GNRI group than in the high-GNRI group. Univariate analysis indicated that alcohol use, preoperative serum C-reactive protein level, lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with OS, while lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with DFS. In multivariate analysis, only GNRI was significantly correlated with OS. DFS and postoperative treatment were independent predictors of DFS. CONCLUSIONS Preoperative GNRI may be a significant prognostic factor in older adults with OSCC. GNRI assessment and nutritional intervention may improve prognosis in patients at high nutritional risk.
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Affiliation(s)
- Yu Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11, Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan.,Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawa-ku, Nagoya, Aichi, Japan
| | - Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawa-ku, Nagoya, Aichi, Japan
| | - Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawa-ku, Nagoya, Aichi, Japan
| | - Momoko Momokita
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawa-ku, Nagoya, Aichi, Japan
| | - Hiroshi Furuta
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11, Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan.,Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawa-ku, Nagoya, Aichi, Japan
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Matsunaga T, Saito H, Osaki T, Takahashi S, Iwamoto A, Fukuda K, Taniguchi K, Kuroda H, Takeuchi T, Sugamura K, Sumi K, Katano K, Shishido Y, Miyatani K, Fujiwara Y. Impact of geriatric nutritional risk index on outcomes after gastrectomy in elderly patients with gastric cancer: a retrospective multicenter study in Japan. BMC Cancer 2022; 22:540. [PMID: 35549906 PMCID: PMC9103416 DOI: 10.1186/s12885-022-09638-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies investigated the utility of inflammation and nutritional markers in predicting the prognosis in patients with gastric cancer; however, the markers with the best predictive ability remain unclear. This retrospective study aimed to determine inflammation and nutritional markers that predicted prognosis in elderly patients over 75 years of age undergoing curative gastrectomy for gastric cancer. METHODS Between January 2005 and December 2015, 497 consecutive elderly gastric cancer patients aged over 75 years underwent curative gastrectomy in 12 institutions. The geriatric nutritional risk index (GNRI), prognostic nutritional index, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and C-reactive protein/albumin ratio were examined as prognostic markers for overall survival (OS) and disease-specific survival (DSS) using area under the curve (AUC) using receiver operating characteristic (ROC) curve analysis. RESULTS The GNRI had the highest AUC and predictive value for both OS (0.637, p < 0.001) and DSS (AUC 0.645, p < 0.001). The study cohort was categorized into the high and low GNRI groups based on the optimal GNRI cut-off values for OS (97.0) and DSS (95.8) determined with the ROC analysis. For both OS and DSS, there was a significant correlation between the GNRI and several clinicopathological factors including age, body mass index, albumin, American Society of Anesthesiologists physical status score, depth of tumor invasion, lymph node metastasis, lymphatic invasion, pathological stage, operation duration, bleeding, procedure, approach, death due to primary disease, and death due to other disease. The GNRI remained a crucial independent prognostic factor for both OS (Hazard ratio [HR] = 1.905, p < 0.001) and DSS in multivariate analysis (HR = 1.780, p = 0.043). CONCLUSIONS Among a panel of inflammation and nutritional markers, the GNRI exhibited the best performance as a prognostic factor after curative gastrectomy in elderly patients with gastric cancer, indicating its utility as a simple and promising index for predicting OS and DSS in these patients.
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Affiliation(s)
- Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, 680-8517, Japan
| | - Tomohiro Osaki
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori, 680-0901, Japan
| | - Sadamu Takahashi
- National Hospital Organization, Hamada Medical Center, Hamada, 697-8511, Japan
| | - Akemi Iwamoto
- Divisions of Digestive Surgery, Tottori Prefectural Kousei Hospital, Kurayoshi, 682-0804, Japan
| | - Kenji Fukuda
- Department of Surgery, Sanin Rosai Hospital, Yonago, 683-8605, Japan
| | - Kenjiro Taniguchi
- Department of Surgery, Yonago Medical Center of National Hospital Organization, Yonago, 683-0006, Japan
| | - Hirohiko Kuroda
- Department of Surgery, Japanese Red Cross Masuda Hospital, Masuda, 698-8501, Japan
| | - Tsutomu Takeuchi
- Department of Surgery, Tottori Seikyo Hospital, Tottori, 680-0833, Japan
| | - Kenji Sugamura
- Department of Surgery, Yasugi Municipal Hospital, Yasugi, 692-0404, Japan
| | - Kenichi Sumi
- Department of Surgery, Hakuai Hospital, Yonago, 683-0853, Japan
| | - Kuniyuki Katano
- Department of Surgery, The Nanbu Town National Health Insurance Saihaku Hospital, Nanbu, 683-0323, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
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Zhou J, Fang P, Li X, Luan S, Xiao X, Gu Y, Shang Q, Zhang H, Yang Y, Zeng X, Yuan Y. Prognostic Value of Geriatric Nutritional Risk Index in Esophageal Carcinoma: A Systematic Review and Meta-Analysis. Front Nutr 2022; 9:831283. [PMID: 35399659 PMCID: PMC8990286 DOI: 10.3389/fnut.2022.831283] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer (EC) is one of the most common cancers worldwide. Malnutrition often leads to poor prognosis of patients with EC. Geriatric nutritional risk index (GNRI) was reported as an objective nutrition-related risk index. We intend to comprehensively review evidence of GNRI in predicting EC prognosis. To explore the influence of GNRI on the long-term survival outcome of patients with EC, a meta-analysis was needed. We searched the Web of Science, Medline, Embase, and the Cochrane Library databases. The association between prognosis of patients with EC and GNRI was evaluated by pooling hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). The fixed model or random model method was chosen according to the heterogeneity among the studies. Totally, 11 studies with 1785 patients who met the inclusion criteria were eventually included in our meta-analysis. Comparing the lower level GNRI group and the higher level GNRI group, the pooled results showed that lower GNRI had a negative impact on overall survival (OS) (HR: 1.75, 95% CI: 1.45–2.10, P < 0.01) and cancer-specific survival (CSS) (HR: 1.77, 95% CI: 1.19–2.62, P < 0.01), indicating that lower GNRI significantly predicted poor OS. In conclusion, lower GNRI could predict the poor prognosis of patients with EC. Meanwhile, more well-designed randomized controlled trials (RCTs) are needed to confirm the findings.
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Affiliation(s)
- Jianfeng Zhou
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Pinhao Fang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xiaokun Li
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Siyuan Luan
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xin Xiao
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Yinmin Gu
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Qixin Shang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Yushang Yang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Yuan
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
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Yang Q, Shen A, Chen X, Guo L, Peng H, Gao M. Clinical Significance of Nutrition and Inflammation in Esophageal Cancer Patients with Surgery: A Meta-Analysis. Nutr Cancer 2022; 74:3128-3139. [PMID: 35341393 DOI: 10.1080/01635581.2022.2056620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many studies have reported that the geriatric nutritional risk index (GNRI) and C-reactive protein to albumin ratio (CAR) may be associated with prognosis of esophageal cancer (EC); however, the results are inconsistent. Therefore, we performed a meta-analysis to evaluate the effect of preoperative GNRI and CAR on the prognosis of EC. PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to analyze the relationship between GNRI/CAR and prognosis. Publication bias was estimated using Begg's funnel plot asymmetry test and Egger's test. A total of 21 studies comprising 5,018 patients were included in the meta-analysis. A decreased GNRI was significantly associated with poorer overall survival (OS) (HR = 1.808, 95% CI: 1.489-2.196, P < 0.001) and cancer-specific survival (CSS) (HR = 1.769, 95% CI: 1.193-2.624, P = 0.005), and an increased CAR was significantly associated with lower OS (HR = 2.179, 95% CI: 1.587-2.992, P < 0.001), CSS (HR = 1.733, 95% CI: 1.333-2.253, P < 0.001), and recurrence-free survival (HR = 2.178, 95% CI: 1.328-3.573, P = 0.002). Thus, preoperative GNRI and CAR may be noninvasive and powerful tools for predicting survival outcomes in patients with EC.
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Affiliation(s)
- Qiuxing Yang
- Cancer Research Center Nantong, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Aiguo Shen
- Cancer Research Center Nantong, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Xudong Chen
- Department of Pathology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Liyuan Guo
- Department of Laboratory, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Hui Peng
- Department of Radiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Mingde Gao
- Department of Urology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
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Preoperative nutritional evaluation of prostate cancer patients undergoing laparoscopic radical prostatectomy. PLoS One 2022; 17:e0262630. [PMID: 35108317 PMCID: PMC8809613 DOI: 10.1371/journal.pone.0262630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background and objective Prostate cancer (PCa) is one of the most common malignant tumors in men. Geriatric Nutritional Risk Index (GNRI) is an objective index for evaluating nutritional status of elderly people over 65 years old. The aim of the current study was to explore the correlation and predictive value between GNRI and postoperative recovery and complications in PCa patients undergoing laparoscopic radical prostatectomy (LRP). Methods Taking 98 as the GNRI boundary value, 96 PCa patients (aged≥65 y) undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were grouped into malnutrition group (MNg, 34 patients, 35.4%) and normal nutrition group (NNg, 62 patients, 64.6%). Basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were recorded and retrospectively analyzed. Clavien-Dindo Classification System (CDCS) was used to assess postoperative complications. T-test was used to analyze differences between the two groups. ROC curve was generated to determine the predictive value of GNRI for postoperative complications. Results Percentage of complications was significantly higher in MNg group compared with that in NNg group (P < 0.01). The average grade based on CDCS was significantly lower in NNg group compared with that in MNg group (P < 0.01). Body weight, Body Mass Index (BMI), preoperative hemoglobin value (HGB), serum albumin (ALB) values of MNg and NNg were significantly positively correlated with GNRI (P<0.01). Incidence and severity of postoperative complications of MNg patients were significantly higher compared with those of NNg patients (P<0.05). Average hospitalization cost of MNg patients was higher in MNg patients compared with that of NNg patients (P<0.05). Duration of post-anesthesia care unit (PACU), duration of antibiotic use and duration of indwelling drainage tube were longer in MNg patients compared with those in NNg patients (P<0.05). Furthermore, volume of indwelling drainage tube was higher in MNg patients compared with that in NNg patients (P<0.05). Conclusion GNRI is an effective and reliable tool for evaluation of preoperative nutritional status of prostate cancer patients. The findings showed that GNRI is correlated with postoperative recovery and complications, and is an effective predictive marker.
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Lidoriki I, Mylonas KS, Syllaios A, Vergadis C, Stratigopoulou P, Marinos G, Mastoraki A, Karavokyros I, Schizas D. The Impact of Nutritional and Functional Status on Postoperative Outcomes following Esophageal Cancer Surgery. Nutr Cancer 2022; 74:2846-2858. [DOI: 10.1080/01635581.2022.2036769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Konstantinos S. Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Georgios Marinos
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Wang H, Li C, Yang R, Jin J, Liu D, Li W. Prognostic Value of the Geriatric Nutritional Risk Index in Non-Small Cell Lung Cancer Patients: A Systematic Review and Meta-Analysis. Front Oncol 2022; 11:794862. [PMID: 35117996 PMCID: PMC8804216 DOI: 10.3389/fonc.2021.794862] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background Novel evidence showed that the Geriatric Nutritional Risk Index (GNRI) may lead to poor prognosis of human cancers. Therefore, we conducted a meta-analysis to explore the impact of GNRI in lung cancer and its prognostic value. Methods We searched the databases of PubMed, Web of Science, Embase, Scopus, and Cochrane Library up to July 2021 for relevant research and merged the hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the association between GNRI and overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) in patients with lung cancer. Results Eight studies involving 2,399 patients were included in our primary meta-analysis. The results indicated that lower level of GNRI was associated with poorer OS, RFS, and CSS of lung cancer patients (OS: HR = 1.99, 95% CI: 1.68–2.35, p < 0.0001; RFS: HR = 2.34, 95% CI: 1.11–4.95, p = 0.0258; CSS: HR = 2.45, 95% CI: 1.43–4.18, p = 0.0011). The association was robust after subgroup analysis and sensitivity analysis. Conclusions GNRI may be a prognostic factor of lung cancer, which can lead to poorer survival. However, more prospective studies are necessary to confirm the results. Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO), identifier CRD42021269574.
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Affiliation(s)
- Haoyu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Cui Li
- Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Ruiyuan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Jin
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weimin Li,
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A simplified frailty score predicts survival and can aid treatment-intensity decisions in older patients with DLBCL. Blood Adv 2021; 5:4771-4782. [PMID: 34543384 PMCID: PMC8759139 DOI: 10.1182/bloodadvances.2021004777] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/04/2021] [Indexed: 11/22/2022] Open
Abstract
A simplified frailty score predicts survival and toxicity in older patients with DLBCL and can inform treatment-intensity decisions. Full-dose R-CHOP is not superior to R-miniCHOP in older unfit DLBCL patients, whereas older fit patients likely benefit from full-dose R-CHOP.
Patients with diffuse large B-cell lymphoma (DLBCL) have a median age of 70 years. Yet, empirical knowledge about the treatment of older patients is limited because they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older real-world population with DLBCL. All patients aged ≥70 years diagnosed with DLBCL between 2006 and 2016 in southeastern Norway (N = 784) were included retrospectively and divided into training (n = 522) and validation (n = 262) cohorts. We constructed and validated a frailty score based on geriatric assessment variables and examined survival and TRM according to frailty status and treatment. The frailty score identified 3 frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival [OS]: fit, 82%; unfit, 47%; frail, 14%; P < .001). For fit patients, full-dose R-CHOP (initial dosage >80%) was associated with better survival than attenuated R-CHOP ([R-miniCHOP]; 2-year OS: 86% vs 70%; P = .012), also in adjusted analyses. For unfit and frail patients, full-dose R-CHOP was not superior to R-miniCHOP, whereas an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with a higher risk for death and TRM, which can aid treatment-intensity decisions in older patients with DLBCL. In this study, fit patients benefited from full-dose R-CHOP, whereas unfit and frail patients had no benefit from full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/.
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Chuang TM, Liu YC, Hsiao HH, Wang HC, Du JS, Yeh TJ, Gau YC, Ke YL, Yang CI, Lee CP, Hsu CM, Cho SF. Low Geriatric Nutritional Risk Index Is Associated with Poorer Prognosis in Elderly Diffuse Large B-Cell Lymphoma Patients Unfit for Intensive Anthracycline-Containing Therapy: A Real-World Study. Nutrients 2021; 13:nu13093243. [PMID: 34579119 PMCID: PMC8468689 DOI: 10.3390/nu13093243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional assessments, including the Geriatric Nutritional Risk Index (GNRI), have emerged as prediction tools for long-term survival in various cancers. This study aimed to investigate the therapeutic strategy and explore the prognostic factors in the elderly patients (≥65 years) with diffuse large B cell lymphoma (DLBCL). The cutoff value of the GNRI score (92.5) was obtained using the receiver operating characteristic curve. Among these patients (n = 205), 129 (62.9%) did not receive standard R–CHOP chemotherapy. Old age (≥80 years), poor performance status, low serum albumin level, and comorbidities were the major factors associated with less intensive anti-lymphoma treatment. Further analysis demonstrated that a lower GNRI score (<92.5) was linked to more unfavorable clinical features. In the patients who received non-anthracycline-containing regimens (non-R–CHOP), multivariate analysis showed that a low GNRI can serve as an independent predictive factor for worse progression-free (HR, 2.85; 95% CI, 1.05–7.72; p = 0.039) and overall survival (HR, 2.98; 95% CI, 1.02–8.90; p = 0.045). In summary, nutritional evaluation plays a role in DLBCL treatment and the GNRI score can serve as a feasible predictive tool for clinical outcomes in frail elderly DLBCL patients treated with non-anthracycline-containing regimens.
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Affiliation(s)
- Tzer-Ming Chuang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yi-Chang Liu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Ching Wang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Shiun Du
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Tsung-Jang Yeh
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yuh-Ching Gau
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ya-Lun Ke
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ching-I Yang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Specialist Nurse and Surgical Nurse Practitioner Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ping Lee
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Chin-Mu Hsu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Shih-Feng Cho
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101
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Lu Z, Li R, Cao X, Liu C, Sun Z, Shi X, Shao W, Zheng Y, Song J. Assessment of Systemic Inflammation and Nutritional Indicators in Predicting Recurrence-Free Survival After Surgical Resection of Gastrointestinal Stromal Tumors. Front Oncol 2021; 11:710191. [PMID: 34381731 PMCID: PMC8350728 DOI: 10.3389/fonc.2021.710191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/29/2021] [Indexed: 12/26/2022] Open
Abstract
Background Recent studies have shown that the systemic inflammation and nutritional indicators are prognostic for a variety of malignancies. However, only limited data have so far demonstrated their usefulness in gastrointestinal mesenchymal tumors (GIST). Methods We retrospectively analyzed the data of GIST patients who underwent radical surgery in Beijing hospital from October 2004 to July 2018. The area under the receiver operating characteristic curve (AUC) was used to compare several commonly used inflammatory and nutritional indicators. The indicators with largest AUC were further analysis. Optimal cut-off values of those indicators in predicting recurrence-free survival (RFS) were determined. Kaplan-Meier curve and the time-dependent receiver operating characteristic (ROC) curve were used to assess the prognostic values. We then used univariate and multivariate Cox regression analyses to identify prognostic factors that were associated with RFS. Results In total, 160 patients who underwent surgery for GIST were included in the study. The median survival time was 34.5 months, with 1-, 3-, and 5-year RFS rates of 96.1%, 84.7%, and 80.8%, respectively. The inflammatory and nutritional indicators with largest AUC were Systemic immunoinflammatory Index (SII) and Geriatric Nutrition Risk Index (GNRI), reached 0.650 and 0.713, respectively. The optimal cutoff of GNRI and SII were 98.3, and 820.0, respectively. Univariate analysis showed that GNRI, SII, KI67, surgery method, tumor location, tumor size, and mitotic index were all significant prognostic indicators of RFS. After multivariate Cox analysis, independent prognostic factors for RFS in GIST included tumor location, mitotic index, tumor size, and GNRI (HR=2.802,95% CI: 1.045 to 7.515, p = 0.041). Besides, SII also tended to be associated with RFS (HR = 2.970, 95% CI: 0.946 to 9.326, p = 0.062). Conclusions High GNRI is an independent prognostic factor for RFS in GIST, while SII can be considered as a prognostic factor. GNRI and SII can be used as tools to evaluate the prognosis of patients before surgery, helping doctors to better treat high-risk patients.
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Affiliation(s)
- Zhenhua Lu
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Li
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianglong Cao
- Department of General Surgery, Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Liu
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Sun
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolei Shi
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weiwei Shao
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Zheng
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinghai Song
- Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Su WT, Tsai CH, Huang CY, Chou SE, Li C, Hsu SY, Hsieh CH. Geriatric Nutritional Risk Index as a Prognostic Factor for Mortality in Elderly Patients with Moderate to Severe Traumatic Brain Injuries. Risk Manag Healthc Policy 2021; 14:2465-2474. [PMID: 34140818 PMCID: PMC8203299 DOI: 10.2147/rmhp.s314487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Geriatric Nutritional Risk Index (GNRI) is a simple and objective screening tool for clinicians to screen patients’ nutritional status based on serum albumin level and their weight and height. The original study had divided patients based on GNRI into quartiles of nutritional risk for death: a no-risk group (GNRI >98), a low-risk group (GNRI 92–98), a moderate-risk group (GNRI 82 to <92), and a major-risk group (GNRI <82). Given that the patients generally sustained traumatic brain injury (TBI) in an acute condition, the study aimed to explore whether GNRI presents a prognostic value for the mortality outcome of these patients. Methods From January 1, 2009, to December 31, 2019, 581 elderly patients with moderate to severe TBI, which was defined as sustaining a head Abbreviated Injury Scale ≥3, was included in the study population. The collected data included age, sex, body mass index, serum albumin levels at admission, preexisting comorbidities, Glasgow Coma Scale, and Injury Severity Score. The primary outcome in the comparison was in-hospital mortality. Results Multivariate logistic regression analysis revealed that GNRI, ESRD, and ISS were significant independent risk factors for mortality in patients with moderate to severe TBI. When subgrouping the study population into four nutritional risk categories according to the quartile deviation as Q1 (GNRI <85, n = 145), Q2 (GNRI 85 to <93.8 n = 145), Q3 (GNRI 93.8 to 103, n = 145), and Q4 (GNRI >103, n = 146), Q1 patients had a significantly longer LOS in hospital (25.2 days vs 18.6 days, respectively; p = 0.004) and higher mortality rate (28.3% vs 11.7%, respectively; p < 0.001) than Q4 patients. The mortality rate was significantly higher in Q1 patients than in Q4 patients (OR, 2.8; 95% CI, 1.14–6.78; p = 0.021). Conclusion This study revealed that the GNRI is a significant independent risk factor and a promising simple assessment tool for mortality in elderly patients with moderate to severe TBI.
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Affiliation(s)
- Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Song F, Ma H, Wang S, Qin T, Xu Q, Yuan H, Li F, Wang Z, Liao Y, Tan X, Song X, Zhang Q, Huang D. Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19. Nutr J 2021; 20:46. [PMID: 34034769 PMCID: PMC8145188 DOI: 10.1186/s12937-021-00702-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and explored the relationship between risk for malnutrition at admission and in-hospital mortality. METHODS A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. The risk for malnutrition was assessed using the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission. RESULTS Two hundred ninety-five patients were enrolled, including 66 severe patients and 41 critically ill patients. Twenty-five deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI, as well as higher CONUT scores, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality. CONCLUSIONS Despite variant screening tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.
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Affiliation(s)
- Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 China
| | - Huan Ma
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080 China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Qing Xu
- Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Huiqing Yuan
- Department of Respiratory and Critical Care Medicine, the First People’s Hospital of Shaoguan, Shaoguan, 512000 China
| | - Fei Li
- Department of Emergency, the First Affiliated Hospital of Jingzhou, Jingzhou, 434000 China
| | - Zhonghua Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Youwan Liao
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Xiaoping Tan
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Xiuchan Song
- Department of Critical Care Medicine, Dongguan Eighth People’s Hospital, Dongguan Children’s Hospital, Dongguan, 523000 China
| | - Qing Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Daozheng Huang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
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Huang SW, Yin SM, Hsieh CH. Association of a Low Geriatric Nutritional Risk Index with Higher Adverse Outcome in the Elderly Patients with Fall Injuries: Analysis of a Propensity Score-Matched Population. Risk Manag Healthc Policy 2021; 14:1353-1361. [PMID: 33833598 PMCID: PMC8023402 DOI: 10.2147/rmhp.s298959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose We evaluate the association of Geriatric Nutritional Risk Index (GNRI) and the adverse outcome in elderly patients (≥65 years old) with fall injuries. Patients and Methods Total 1071 elderly patients with fall injuries were enrolled. Patients were divided into four groups: high risk, moderate risk, low risk and no risk (GNRI: <82, 82 to <92, 92 to ≤98 and >98) for patient demography, comorbidities, and adverse outcomes analysis. Results After 1:1 propensity score-matched analysis, 97 patients in high-risk group, 144 patients in moderate-risk group, and 114 patients in low-risk group were compared to no risk group. High-risk group patients had a 5.7-fold higher risk of mortality (p = 0.003) and prolong hospital stay (18.0 vs 12.3 days; p = 0.016) when compared to no-risk group patients. Significantly prolong hospital stay were also found in low-risk and moderate-risk group when compared to no risk group. Conclusion A lower GNRI is associated with prolonged hospital stay in the elderly patients with fall injuries. High nutritional risk (GNRI < 82) is associated with an increased in-hospital mortality rate.
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Affiliation(s)
- Szu-Wei Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shih-Min Yin
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
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Lidoriki I, Schizas D, Mylonas KS, Vergadis C, Karydakis L, Alexandrou A, Karavokyros I, Liakakos T. Postoperative Changes in Nutritional and Functional Status of Gastroesophageal Cancer Patients. J Am Coll Nutr 2021; 41:301-309. [PMID: 33704025 DOI: 10.1080/07315724.2021.1880986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Disease-related malnutrition is a debilitating condition frequently observed in patients with cancer. The aim of the current study was to prospectively examine postoperative changes in nutritional and functional status of patients undergoing surgery for gastric, esophageal, and gastroesophageal junction cancer. METHODS Participants were prospectively recruited from September 2015 to September 2019. The assessment of malnutrition was based on the Patient-Generated Subjective Global Assessment tool. The functional assessment included the evaluation of muscle strength and physical performance, while muscle mass assessment was based on Skeletal Muscle Mass Index (SMI) derived from the analysis of computed tomography scans. The follow up of patients was scheduled at six months postoperatively. RESULTS A total of 98 patients were analyzed. Mean patient age was 60.79 ± 10.19 years and 80.6% were males. The mean unintentional weight loss at 6 months was 11.7 ± 8.0%. Patients who underwent McKeown esophagectomy reported the greatest weight loss postoperatively (16.2 ± 9.6%), whereas the lowest rate of weight loss was observed in patients who underwent partial gastrectomy (5.6 ± 6.7%). The rate of severe malnutrition declined at six months postoperatively (39.7% vs 27%). Muscle strength and physical performance were significantly deteriorated at 6 months postoperatively, except for the group of partial gastrectomy, while SMI significantly decreased in all groups of patients except for McKewon esophagectomy group. Finally, the prevalence of low muscle mass increased significantly from 43.5% in the preoperative period to 66.7% at the follow-up. CONCLUSIONS Our study revealed a significant deterioration in gastroesophageal cancer patient nutritional and functional status at six months postoperatively. The high prevalence of malnutrition and low muscle mass requires systematic follow-up and multidirectional monitoring in order to ensure the successful rehabilitation of these patients.
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Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Lysandros Karydakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodoros Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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50
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Chang LW, Hung SC, Li JR, Chiu KY, Yang CK, Chen CS, Lu K, Chen CC, Wang SC, Lin CY, Cheng CL, Ou YC, Yang SF, Hsu CY, Ho SH, Wang SS. Geriatric Nutritional Risk Index as a Prognostic Marker for Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel. Front Pharmacol 2021; 11:601513. [PMID: 33569000 PMCID: PMC7868324 DOI: 10.3389/fphar.2020.601513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose: To investigate the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in patients with metastatic Castration–resistant Prostate Cancer (mCRPC) receiving docetaxel as the first line of treatment. Methods: We retrospectively reviewed patients with mCRPC and receiving first line docetaxel in Taichung Veterans General Hospital from 2006 to 2012. The GNRI was calculated using serum albumin and body mass index, with a poor nutritional status defined as GNRI <92.0. Multivariate Cox-regression analysis was used to evaluate the risk of survival. Results: One-hundred seventy patients with mCRPC were included. One-hundred twenty-five patients were of normal nutritional status (GNRI ≥92) and 45 patients were of poor nutritional status (GNRI <92). The cumulative docetaxel dosage was 600 (360–1,185) mg in the normal nutritional status group and 360 (127.5–660) mg in the poor nutritional status group (p < 0.001). The median overall survival from mCRPC was 30.39 months in the good nutritional status group and 11.07 months in the poor nutritional status group (p of log rank <0.001). In a multivariate model, poor nutritional status was an independent risk factor in overall survival (Hazard Ratio [HR] = 5.37, 95% Confidence Interval [CI] 3.27–8.83), together with a high metastatic volume (HR = 4.03, 95% CI 2.16–7.53) and docetaxel cumulative dosage (HR = 0.999, 95% CI 0.999–0.9998). Conclusion: Poor nutritional status with a GNRI <92 is associated with shorter progression free survival and overall survival in mCRPC patients treated with docetaxel. Metastatic volume and cumulative docetaxel dosage are also independent prognostic factors in overall survival.
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Affiliation(s)
- Li-Wen Chang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kevin Lu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Che Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chi Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Urology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Hang Ho
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
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