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ROC curves for nutritional status according to NutricScore, OPNI and GNRI to predict 30-day mortality
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Background
There are several screening tools used in the detection of malnutrition to facilitate nutritional support and predict prognosis in the elderly.
Aims
We aimed to compare the prognostic predictive value of geriatric nutritional risk index (GNRI) with other nutritional indices on 1 month survival in geriatric patients hospitalized for resp...
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Predicting the clinical progression of intensive care unit (ICU) patients is crucial for survival and prognosis. Therefore, this retrospective study aimed to develop the risk scoring system of mortality and the prediction model of ICU length of stay (LOS) among patients admitted to the ICU. Data from ICU patients aged at least 18 years who received...
Citations
... GNRI has demonstrated predictive value for mortality in earlier studies involving chronic renal failure [18], heart failure [19], and respiratory failure [20,21]. While several studies have explored the association between GNRI and short-term complications after cancer surgery [9,22,23], there is limited research on the long-term prognosis of GNRI in cancer patients post-surgery. ...
Purpose
The Geriatric Nutrition Risk Index (GNRI) is a simple and validated tool used to assess the nutritional status of elderly patients and predict the risk of short-term postoperative complications, as well as the long-term prognosis, after cancer surgery. In this study, we aimed to evaluate the predictive value of GNRI for the long-term postoperative prognosis in elderly patients with primary non-muscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT).
Methods
We retrospectively analyzed data from 292 elderly patients with primary NMIBC. Using X-tile software, we divided the cohort into two groups based on GNRI and determined the cut-off value for postoperative recurrence-free survival (RFS). Propensity score matching (PSM) with a ratio of 1:3, Kaplan–Meier analysis, log-rank test, and COX proportional hazards regression were used to assess the correlation between GNRI and prognosis and identify factors predicting recurrence and progression.
Results
In the entire cohort, the 3 year recurrence group had significantly lower GNRI compared to the 3 year non-recurrence group (P = 0.0109). The determined GNRI cut-off value was 93.82. After PSM, the low GNRI group had significantly lower RFS (P < 0.0001) and progression-free survival (PFS) (P = 0.0040) than the high GNRI group. Multivariate COX regression showed that GNRI independently predicted RFS (HR 2.108; 95% CI 1.266–3.512; P = 0.004) and PFS (HR 2.155; 95% CI 1.135–4.091; P = 0.019) in elderly patients with primary NMIBC.
Conclusion
Preoperative GNRI is a prognostic marker for disease recurrence and progression in elderly patients with primary NMIBC undergoing TURBT.
... The GNRI was calculated from height, weight, and serum albumin, which is used to assess the patient's nutritional status in the pathological state [18]. When the actual body weight exceeds the ideal body weight, the actual body weight/ideal body weight is set to 1, otherwise it is recorded as the actual value [19]. ...
Background
Malnutrition is recognized as a risk factor for osteoporosis and T2DM. Previous studies have demonstrated the relationship between nutritional assessment tools and BMD. However, few studies have compared the effects of three nutritional risk assessment tools (GNRI, CONUT, and PNI). This study aimed to investigate the correlation between three nutritional assessment tools and BMD and to compare their validity in predicting osteoporosis in type 2 diabetes mellitus in the elderly.
Methods
This retrospective study collected clinical data from 525 elderly patients with type 2 diabetes mellitus and categorized the patients into osteoporotic and non-osteoporotic groups. The correlation between the three nutritional assessment tools and BMD was analyzed using Spearman partial correlation. Binary logistics regression was used to analyze the relationship between GNRI and osteoporosis. ROC curves were used to compare the validity of GNRI, PNI, and CONUT in predicting osteoporosis.
Results
Spearman’s partial correlation showed a positive correlation between femoral neck BMD and lumbar spine BMD, but no correlation was observed between total hip BMD and GNRI. Logistic regression analyses showed no association between PNI, CONUT scores, and the development of osteoporosis. After adjusting for age, sex, smoking, alcohol consumption, BMI, ALB, Cr, UA, FBG, TG, and HDL, the correlation between GNRI and osteoporosis remained. ROC curve analysis showed that GNRI in combination with age and albumin had better predictive ability for osteoporosis than PNI and CONUT.
Conclusion
GNRI was an independent protective factor against osteoporosis in elderly patients with T2DM, and the predictive ability of GNRI for osteoporosis in elderly patients with T2DM was better than that of PNI and CONUT scores.
... This index was first developed by Bouillanne et al. in 2005 13 and has been widely validated as a reliable prognostic nutritional index for patients with various clinical conditions, such as acute ischemic stroke, heart failure, respiratory failure, and malignancies. 16,17,[23][24][25] This study is the first to assess the nutritional status of patients with IPF using GNRI. We found that 37.5% of all patients with IPF receiving antifibrotic therapy had malnutrition-related risk (GNRI < 98) defined by GNRI. ...
Background and objective:
Idiopathic pulmonary fibrosis (IPF) is characterized by progressive lung fibrosis of unknown aetiology. Epidemiological studies have suggested that IPF progression may negatively affect nutritional status. Weight loss during antifibrotic therapy is also frequently encountered. The association of nutritional status and outcome has not been fully evaluated in IPF patients.
Methods:
This retrospective multicohort study assessed nutritional status of 301 IPF patients receiving antifibrotic therapy (Hamamatsu cohort, n = 151; Seirei cohort, n = 150). Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). The GNRI was calculated based on body mass index and serum albumin. The relationship between nutritional status and tolerability of antifibrotic therapy as well as mortality was explored.
Results:
Of 301 patients, 113 (37.5%) had malnutrition-related risk (GNRI < 98). Patients with malnutrition-related risk were older, had increased exacerbations and worse pulmonary function than those without a GNRI status <98. Malnutrition-related risk was associated with a higher incidence of discontinuation of antifibrotic therapy, particulary due to gastrointestinal disturbances. IPF patients with malnutrition-related risk (GNRI < 98) had shorter survival than those without such risk (median survival: 25.9 vs. 41.1 months, p < 0.001). In multivariate analysis, malnutrition-related risk was a prognostic indicator of antifibrotic therapy discontinuation and mortality, independent of age, sex, forced vital capacity, or gender-age-physiology index.
Conclusion:
Nutritional status has significant effects on the treatment and outcome in patients with IPF. Assessment of nutritional status may provide important information for managing patients with IPF.
... The GNRI was originally developed to assess the risks of malnutrition and malnutrition-related mortality and morbidity in hospitalized patients. The utility of GNRI has since been evaluated in a range of clinical conditions, including infectious and neoplastic diseases [11][12][13][14], and is now used for nutritional assessment in a wide range of diseases [15][16][17]. The GNRI has been validated as a simple indicator of nutritional status that is more comprehensive than body mass index (BMI). ...
... The GNRI, consisting of BMI and serum albumin levels, is a valid tool for assessing malnutrition-related morbidity [10] and mortality in patients with various clinical conditions including acute ischaemic stroke, heart failure, respiratory failure and malignancies [13][14][15][16][17]. However, there have been no studies using GNRI to assess the nutritional status of patients with iPPFE who often have lower BMI and slender body types. ...
Background
Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterised by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma, with advanced cases often complicated by progressive weight loss. Therefore, we hypothesized that nutritional status is associated with mortality in iPPFE.
Methods
This retrospective study assesses nutritional status at the time of diagnosis and one year after diagnosis in 131 patients with iPPFE. Malnutrition-related risk was evaluated using the Geriatric Nutritional Risk Index (GNRI).
Results
Of the 131 patients, 96 (76.3%) were at malnutrition-related risk at the time of diagnosis according to GNRI. Of these, 21 patients (16.0%) were classified as at major malnutrition-related risk (GNRI <82). Patients at major malnutrition-related risk were significantly older and had worse pulmonary function than patients at low (92≤ GNRI <98)- and moderate (82≤ GNRI <92)-malnutrition-related risk. GNRI scores decreased significantly from the time of diagnosis to one year after diagnosis. Patients with lower GNRI (<91.7) had significantly shorter survival than patients with a median GNRI or higher (≥91.8). Patients with declines in annual GNRI scores of 5 or greater had significantly shorter survival than patients with declines in GNRI scores of less than 5. In multivariate analysis, major malnutrition-related risk was significantly associated with increased mortality after adjustment for age, sex and forced vital capacity (hazard-ratio, 1.957). A composite scoring model including age, sex, and major malnutrition-related risk was able to separate mortality risk in iPPFE.
Conclusion
Assessment of nutritional status by GNRI provides useful information for managing patients with iPPFE by predicting mortality risk.
... The GNRI was originally developed to assess the risks of malnutrition and malnutrition-related mortality and morbidity in hospitalised patients. The utility of GNRI has since been evaluated in a range of clinical conditions, including infectious and neoplastic diseases [7][8][9][10], and is now used for nutritional assessment in a wide range of diseases [11][12][13]. The GNRI has been validated as a simple indicator of nutritional status that is more comprehensive than body mass index (BMI). ...
... The GNRI, consisting of BMI and serum albumin levels, is a valid tool for assessing malnutrition-related morbidity [6] and mortality in patients with various clinical conditions including acute ischaemic stroke, heart failure, respiratory failure and malignancies [9][10][11][12][13]. However, there have been no studies using GNRI to assess the nutritional status of patients with iPPFE who often have lower BMI and slender body types. ...
Background: Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterized by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma, with advanced cases often complicated by progressive weight loss. Therefore, we hypothesised that nutritional status is associated with mortality in iPPFE.
Methods: This retrospective study assesses nutritional status at the time of diagnosis and one year after diagnosis in 125 patients with iPPFE. Malnutrition-related risk was evaluated using the Geriatric Nutritional Risk Index (GNRI).
Results: Of the 125 patients, 96 (76.8%) were at malnutrition-related risk at the time of diagnosis according to GNRI. Of these, 21 patients (16.8%) were classified as at major malnutrition-related risk (GNRI <82). Patients at major malnutrition-related risk were significantly older and had worse pulmonary function than patients at low (92≤ GNRI <98)- and moderate (82≤ GNRI <92)-malnutrition-related risk. GNRI scores decreased significantly from the time of diagnosis to one year after diagnosis. Patients with lower GNRI (<91.7) had significantly shorter survival than patients with a median GNRI or higher (≥91.7). Patients with declines in annual GNRI scores of 5 or greater had significantly shorter survival than patients with declines in GNRI scores of less than 5. In multivariate analysis, major malnutrition-related risk was significantly associated with increased mortality after adjustment for age, sex and forced vital capacity (hazard-ratio, 1.946). A composite scoring model including age, sex and major malnutrition-related risk was able to separate mortality risk in iPPFE.
Conclusion: Assessment of nutritional status by GNRI provides useful information for managing patients with iPPFE by predicting mortality risk. (250 words)
... Other studies used nutrition screening tools that mainly relied on biochemical indices such as serum albumin (i.e. controlling nutritional status index [CONUT], 12 prognostic nutritional index [PNI], 12 geriatric nutritional risk index [GNRI], 10,11,14 and Onodera's prognostic nutritional index [OPNI]). 10 They reported 43.9-76.3% of older ICU patients had biochemical derangements. ...
... controlling nutritional status index [CONUT], 12 prognostic nutritional index [PNI], 12 geriatric nutritional risk index [GNRI], 10,11,14 and Onodera's prognostic nutritional index [OPNI]). 10 They reported 43.9-76.3% of older ICU patients had biochemical derangements. A study that used mid-arm circumference reported that 23.3% of older ICU patients had measurements below the 10th percentile of a populationspecific database. ...
... 15 Older ICU patients with high mNUTRIC score had increased ICU, hospital or 30-day mortality, and ICU/ hospital length of stay. 10,16 However, patients with high mNUTRIC and achieved ≥80% prescribed calories and protein had lower ICU and/or hospital mortality. 16 ...
Introduction:
There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population.
Method:
MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied.
Results:
Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia.
Conclusion:
Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
... Among these tools, GNRI is a scoring tool specific for elderly patients. Clinical studies found that GNRI can predict the short-term prognosis of critically ill patients, such as those with heart failure, respiratory failure, and sepsis (6,24,25), and the long-term prognosis of patients with cancer (8). These studies showed that GNRI has a certain relationship with the prognosis of severely ill elderly patients, but most studies have small samples. ...
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.
... These results are in line with the current literature (45)(46)(47) that low hemoglobin is associated with adverse clinical outcomes among older adults. Moreover, previous research indicates that the Geriatric Nutrition Risk Index (GNRI) (42) combined with biochemical objective indicators, such as albumin, can be used to identify and diagnose malnutrition and can better predict 30day mortality rate in older patients (48). In addition, Hong et al. (49) and Pérez-Ros et al. (50) indicated that compared with the robust, levels of hemoglobin showed lower values among the prefrail and frail group, and nutritional markers may be used for the evaluation of adverse clinical outcomes in older patients. ...
Background
Studies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes.
Methods
This prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization.
Results
We found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0–7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8–11 (OR 3.283, 95% CI 2.126–5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12–14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0–7 (regression coefficient 0.2807, 95% CI 0.0294–0.5320; P < 0.05) and a score of 8–11 (0.2574, 95% CI 0.0863–0.4285; P < 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12–14. MNA-SF scores 0–7 (OR 1.393, 95% CI 1.052–1.843) and 8–11 (OR 1.356, 95% CI 1.124–1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12–14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24–27.9 kg/m², age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population.
Conclusions
Malnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.
... [2] and the cut-off was 91 (40,41) which means at risk patients were <91. ...
Background: The frailty score has been developed to determine physiological functioning capacity. The
aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery
patients.
Methods: Our research is an observational, single-center, prospective cohort study (registered on
ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery
between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained
questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and
depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional
Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated
as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze
survival and relative risk. The primary outcome was mid-term mortality.
Results: The patients’ mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup
was 1,656 days of survival [interquartile range (IQR), 1,336–2,081 years], during this period 14 patients
died. The median of EuroSCORE II was 1.56 (1.00–2.58) points. The median preoperative albumin level
was 32.80 g/L (IQR, 29.9–35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred
7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term
survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10–25.91, P=0.037]. After adjustment for EuroSCORE
II and postoperative complications the noncardiovascular CGA score was associated with overall mortality
[adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02–2.04, P=0.036]. In the multivariable Cox regression,
GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52–14.92, P=0.007).
Conclusions: The CGA-based noncardiovascular score and nutritional status should be assessed before
cardiac surgery prehabilitation and may help decrease long-term mortality.
Keywords: Frailty; frailty score; nutrition; Geriatric Nutritional Risk Index (GNRI); cardiac surgery
... One retrospective study conducted in South Korea proposed that the geriatric nutritional risk index (GNRI) is associated with 30-day mortality in elderly patients with ARDS [34]. However, another report noted the GNRI's low specificity (57.1%) compared with the specificity of other nutritional indexes such as NRS 2002 and Onodera's prognostic nutritional index for short-term outcomes in geriatric patients with respiratory failure [35]. In addition, the applicability of the GNRI may be limited because it is used to evaluate the geriatric population [36]. ...
Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07–0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.
