The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

Association between the geriatric nutritional risk index and adverse post-extubation outcomes for critically ill older adults: a retrospective study

BACKGROUND AND PURPOSE

Malnutrition commonly predicts adverse outcomes among older adults in the intensive care unit (ICU). The Geriatric Nutritional Risk Index (GNRI) is a simple and practical tool for assessing nutritional status in older adults. This study aims to explore the association between GNRI and adverse post-extubation outcomes in critically ill older adults.

METHODS

A total of 1,153 older adults aged 65-82 years in the ICU were included in this retrospective cohort study. GNRI categories were stratified into four subgroups based on nutritional risk: major risk (GNRI < 82), moderate risk (GNRI 82-91), low risk (GNRI 92-98), and no risk (GNRI > 98). Adverse post-extubation outcomes included mortality or pneumonia within 30 days post-extubation, reintubation within 72 h, post-extubation dysphagia, and length of stay (LOS) in the ICU and hospital. Multivariable logistic regression analysis and restricted cubic spline (RCS) were used to explore the association between GNRI categories and dichotomous adverse outcomes. Additionally, multivariable linear regression was used to evaluate the association between GNRI and LOS in the ICU and hospital.

RESULTS

Older adults with dichotomous adverse outcomes had lower GNRI values compared with those without (P-value<0.001), and increasing LOS in ICU and hospital was associated with decreasing GNRI value (P for trend<0.001). Patients at major nutritional risk had the highest risk of mortality [OR = 2.76, 95%CI: 1.40 ∼ 5.46] or pneumonia [OR = 3.07, 95%CI: 1.42 ∼ 6.68] within 30 days post-extubation, reintubation within 72 h [OR = 2.41, 95%CI: 1.06 ∼ 5.49] and post-extubation dysphagia [OR = 2.94, 95%CI: 1.19 ∼ 7.31](P for trend<0.001). The RCS study also validated the linear relationship between GNRI and mortality/pneumonia within 30 days post-extubation and post-extubation dysphagia. Conversely, there were non-linear associations between GNRI and ICU and hospital LOS, as well as reintubation within 72 h. Furthermore, GNRI showed a significant negative correlation with LOS in both the ICU and hospital. Kaplan-Meier curve analysis demonstrated that survival within 30 days post-extubation was significantly reduced in major nutritional risk group compared to the no risk group (P-value = 0.018).

CONCLUSIONS

Our findings demonstrated that major nutritional risk defined by GNRI was associated with a higher risk of adverse post-extubation outcomes in critically ill older adults.

Breaking new ground: machine learning enhances survival forecasts in hypercapnic respiratory failure

Background

The prognostic prediction of patients with hypercapnic respiratory failure holds significant clinical value. The objective of this study was to develop and validate a predictive model for predicting survival in patients with hypercapnic respiratory failure.

Methods

The study enrolled a total of 697 patients with hypercapnic respiratory failure, including 565 patients from the First People's Hospital of Yancheng in the modeling group and 132 patients from the People's Hospital of Jiangsu Province in the external validation group. The three selected models were random survival forest (RSF), DeepSurv, a deep learning-based survival prediction algorithm, and Cox Proportional Risk (CoxPH). The model's predictive performance was evaluated using the C-index and Brier score. Receiver operating characteristic curve (ROC), area under ROC curve (AUC), and decision curve analysis (DCA) were employed to assess the accuracy of predicting the prognosis for survival at 6, 12, 18, and 24 months.

Results

The RSF model (c-index: 0.792) demonstrated superior predictive ability for the prognosis of patients with hypercapnic respiratory failure compared to both the traditional CoxPH model (c-index: 0.699) and DeepSurv model (c-index: 0.618), which was further validated on external datasets. The Brier Score of the RSF model demonstrated superior performance, consistently measuring below 0.25 at the 6-month, 12-month, 18-month, and 24-month intervals. The ROC curve confirmed the superior discrimination of the RSF model, while DCA demonstrated its optimal clinical net benefit in both the modeling group and the external validation group.

Conclusion

The RSF model offered distinct advantages over the CoxPH and DeepSurv models in terms of clinical evaluation and monitoring of patients with hypercapnic respiratory failure.

High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies

Introduction: Pancreaticoduodenectomy (PD) is a major surgery associated with significant morbidity and mortality, especially in older adult patients. Malnutrition is a common complication in these patients and is linked to poorer outcomes. This study aimed to investigate the associations between preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) and postoperative outcomes in older adult patients who underwent PD. Methods: A retrospective cohort study was conducted on 363 older adult patients who underwent PD. The preoperative GNRI was calculated based on serum albumin levels and body mass index. GNRI ≤ 82, GNRI 83 to ≤98, and GNRI > 98 were classified as severely malnourished, moderately/mildly malnourished, and no malnourishment, respectively. Perioperative data, including demographics, comorbidities, and postoperative complications, were collected. Univariate and multivariate analyses were performed to assess the associations between the GNRI and outcomes such as length of hospital stay, postoperative complications, and overall survival. Results: Patients with a higher GNRI were more likely to experience Clavien-Dindo grade ≥ 3b postoperative complications (42.1% vs. 22.0% vs. 14.1%; p = 0.027) and pulmonary complications (26.3% vs. 11.9% vs. 4.2%; p = 0.016). These patients also stayed at the hospital for a longer duration (17.0% vs. 16.0% vs. 11.0%; p < 0.001). Multivariate analysis confirmed that the GNRI was an independent predictor of adverse outcomes, even after adjusting for other confounding factors. Conclusions: Our findings highlight the importance of preoperative nutritional assessment in older adult patients undergoing PD. Patients with low GNRI scores are at increased risk of postoperative complications and prolonged recovery. These results underscore the need for targeted nutritional interventions and regular monitoring of these patients. Future studies should focus on interventions to improve nutritional status in older adult patients undergoing PD.

The association between nutrition risk status assessment and hospital mortality in Chinese older inpatients: a retrospective study

PURPOSE

The association between nutritional risk status assessment and hospital mortality in older patients remains controversial. The aim of this study was to assess the relationship between nutritional risk on admission and in-hospital mortality, and explore the best Nutritional Risk Status Screening 2002 (NRS2002) threshold for predicting in-hospital mortality of older inpatients in China.

METHOD

The elderly inpatients were recruited from a hospital in Hunan Province, China. Nutritional risk was screened and assessed using the NRS2002. Logistic regression was used to analyze whether NRS2002 scores were independently associated with hospital mortality, and the results were expressed as odds ratios (OR) and 95% confidence intervals (CIs). Receiver operating characteristic curve (ROC) was used to determine the best NRS2002 threshold for predicting in-hospital mortality in elderly inpatients. And 500 bootstrap re-samplings were performed for ROC analysis.

RESULT

In total, 464 elderly inpatients completed the survey (15 of whom died, 205 males and 259 females, mean age = 72.284 ± 5.626 years). Multifactorial analysis revealed that age, the NRS2002 score, and length of hospital stay significantly influenced in-hospital mortality among older inpatients (P < 0.05). The results also showed that higher NRS2002 scores were associated with an increased risk of in-hospital mortality in both the unadjusted (OR = 1.731,95%CI = 1.362-2.20, P < 0.0001), adjusted model I (OR = 1.736, 95% CI = 1.354-2.206, P < 0.0001) and model II (OR = 1.602, 95% CI = 1.734-2.488, P = 0.0005). The optimal NRS2002 threshold for predicting in-hospital mortality in older inpatients was 3.5, with the largest ROC area of 0.84.

CONCLUSION

Our findings indicated that nutritional risk was an independent predictor of in-hospital mortality, with a cut-off value of 3.50 for the NRS2002 nutritional risk assessment being more appropriate than a cut-off value of 3.0.

Geriatric Nutritional Risk Index and 30-Day Postoperative Mortality in Geriatric Burn Patients

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.

Comparison of nutritional risk indices (PNI, GNRI, mNUTRIC) and HALP score in predicting adverse clinical outcomes in older patients staying in an intensive care unit

Malnutrition among critically ill older patients is a frequent problem in intensive care units (ICUs) and is associated with a higher risk of hospital/ICU length of stay (LOS) and mortality. The aim of this study was to evaluate malnutrition in older patients staying in an ICU using the hemoglobin, albumin, lymphocyte, platelet (HALP) score, modified nutrition risk in the critically Ill (mNUTRIC), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) and to determine the consistency between these tools and their association with clinical outcomes. This cross-sectional retrospective, observational, hospital-based study included 153 older patients (≥65 years of age), who were admitted to an internal medicine ICU. Sequential organ failure assessment (SOFA) scores and acute physiology and chronic health evaluation (APACHE) II were used to assess disease severity. Nutritional status was evaluated using mNUTRIC, GNRI, PNI, and HALP scores, and their association with ICU LOS and mortality was evaluated using ROC and regression analyses. The mortality rate of the patients was 43.1%. The risk of malnutrition was higher among non-survivors, with mNUTRIC scores showing a significant difference between the groups. The scores for all indices, except HALP, showed significant differences between the groups. APACHE-II, SOFA, and mNUTRIC were the strongest prognostic indices for ICU mortality, with mNUTRIC having the highest sensitivity and negative predictive value. The HALP score was not associated with ICU LOS or a significant prognostic factor for mortality. All indices except HALP were good indicators of clinical outcomes in the study population including older patients. Prospective studies in larger and specific patient populations are needed to draw a strict conclusion in this subject.

Role of composite objective nutritional indexes in patients with chronic kidney disease

Malnutrition persists as one of the most severe symptoms in patients with chronic kidney disease (CKD) globally. It is a critical risk factor for cardiovascular and all-cause mortality in patients with CKD. Readily available objective indicators are used to calculate composite objective nutritional assessment indexes, including the geriatric nutritional risk index, prognostic nutritional index, and controlling nutritional status score. These indexes offer a straightforward and effective method for evaluating nutritional status and predicting clinical outcomes in patients with CKD. This review presents supporting evidence on the significance of composite nutritional indexes.

Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

BACKGROUND

Elderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes.

METHODS

A hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted.

RESULTS

The prevalence of high-nutritional risk was 45.5% (95% CI, 40%-51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37-17.45), HAIs (AOR: 3.18; 95% CI, 1.48-6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04-18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk.

CONCLUSION

GNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort

OBJECTIVE

To determine whether the Geriatric Nutritional Risk Index (GNRI) on hospital admission was associated to an increased 14-day and 12-month mortality-risk in older inpatients with COVID-19.

METHODS

Cohort study of consecutive inpatients admitted with COVID-19 in a university hospital (20/03/2020-11/05/2021).

INCLUSION CRITERIA

age over 65 years and positive polymerase chain reaction test.

EXCLUSION CRITERIA

missing data for weight, height, and/or albumin, hospital-acquired COVID-19, or patients transferred to other health facilities.

OUTCOME

all-cause mortality at 14-day and 12-month follow-up. GNRI [1.489 × albumin (g/L)] + [41.7 (weight/ideal body weight)] was assessed at admission; scores ≤98 indicated risk of malnutrition. Cox-proportional hazards models assessed the association between the admission GNRI and 14-day and 12-month mortality-risk, after adjusting by demographic and clinical variables, including inflammation (C-reactive protein).

RESULTS

Of the 570 eligible patients, 224 (mean age 78 years; 52.2% women) met inclusion criteria and 151 (67.4%) were classified at risk of malnutrition. Twenty patients died during the 14-day and 42 during the 12-month follow-up. The risk of 14-day mortality was nearly 10 times higher in patients with GNRI scores ≤98 (HR = 9.6 [95%CI 1.3-71.6], P = 0.028); this association was marginally significant in the adjusted model (HR = 6.73 [95%CI 0.89-51.11], P = 0.065)]. No association between GNRI and the 12-month mortality-risk was found.

CONCLUSIONS

The GNRI may play a role in the short-term prognosis of older inpatients with COVID-19. Further studies are required to confirm the short-term predictive validity of the GNRI within this population (Clinicaltrials.gov_NCT05276752).

The prognostic effects of the geriatric nutritional risk index on elderly acute kidney injury patients in intensive care units

Introduction

The geriatric nutritional risk index (GNRI), a nutritional screening tool specifically for the aging population, has been proven to be associated with worse outcomes in chronic kidney disease patients, especially in the hemodialysis population. However, the predictive validity of GNRI in critically ill elderly patients with acute kidney injury (AKI) is yet to be determined. This analysis sought to examine the prognostic effects of GNRI on elderly AKI patients in intensive care units (ICUs).

Methods

We collected elderly AKI patient-relevant data from the Medical Information Mart for Intensive Care III database. AKI was diagnosed and staged according to the "Kidney Disease Improving Global Outcomes" criteria. In the study, 1-year mortality was considered the primary outcome, whereas in-hospital, ICU, 28-day and 90-day mortality, and prolonged length of stay in ICU and hospital were selected as the secondary outcomes.

Results

In all, 3,501 elderly patients with AKI were selected for this study, with a 1-year mortality rate of 36.4%. We classified the study population into low (≤98) and high (>98) GNRI groups based on the best cutoff value. The incidence of endpoints was remarkably lower in patients with elevated GNRI (p < 0.001). When stratified by the AKI stage, patients with high GNRI at AKI stages 1, 2, and 3 had markedly lower 1-year mortality than those with low GNRI (all p < 0.05). The multivariable regression analysis identified the independent prognostic ability of GNRI on the research outcomes (all p < 0.05). Restricted cubic spline exhibited a linear correlation between GNRI and 1-year death (p for non-linearity = 0.434). The prognostic implication of GNRI on 1-year mortality was still significant in patients with the most subgroups.

Conclusion

In critically ill elderly patients with AKI, elevated GNRI upon admission was strongly correlated with a lower risk of unfavorable outcomes.

The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database

BACKGROUND

The purpose of this article is to assess the relationship between serum albumin level and long length of stay (LOS) of inpatients with acute heart failure (AHF) in the intensive care unit (ICU).

METHODS

We retrospectively analyzed data of 2280 patients with AHF from the medical information mart for intensive care IV (the MIMIC-IV) database. Multivariate logistic regression was performed to evaluate the association between serum albumin and long LOS, and the development of the predictive model was based on independent predictors of long LOS.

RESULTS

According to the statistical results, A negative linear relationship was presented between albumin and long LOS of AHF patients in the ICU (P for trend <0.001), and serum albumin could predict long LOS (AUC 0.649, 95%CI 0.616-0.683, P <0.001). Based on independent predictors, including respiratory failure (OR 1.672, 95%CI 1.289-2.169, P<0.001), WBC (OR 1.046, 95%CI 1.031-1.061, P<0.001), creatinine (OR 1.221, 95%CI 1.098-1.257, P<0.001), glucose (OR 1.010, 95%CI 1.007-1.012, P<0.001), lactic acid (OR 1.269, 95%CI 1.167-1.381, P<0.001), and albumin (OR 0.559, 95%CI 0.450-0.695, P<0.001), identified by multivariable logistic regression analysis, we developed the nomogram to predict the probability of long LOS of AHF patients in the ICU. The nomogram accurately predicted the probability of long LOS (AUC 0.740, 95%CI 0.712-0.768, P<0.001). The calibration suggested the predictive probability was highly consistent with the actual probability of long LOS. Decision curve analysis (DCA) also suggested that the nomogram was applicable in the clinic.

CONCLUSION

Serum albumin level was negatively associated with LOS among AHF patients. The predictive model based on serum albumin has predictive value for evaluating the length of stay in AHF patients.

Construction of a mortality risk prediction model for elderly people at risk of lobectomy for NSCLC

Background

An increasing number of lung cancer patients are opting for lobectomy for oncological treatment. However, due to the unique organismal condition of elderly patients, their short-term postoperative mortality is significantly higher than that of non-elderly patients. Therefore, there is a need to develop a personalised predictive tool to assess the risk of postoperative mortality in elderly patients.

Methods

Information on the diagnosis and survival of 35,411 older patients with confirmed lobectomy NSCLC from 2009 to 2019 was screened from the SEER database. The surgical group was divided into a high-risk mortality population group (≤90 days) and a non-high-risk mortality population group using a 90-day criterion. Survival curves were plotted using the Kaplan-Meier method to compare the differences in overall survival (OS) and lung cancer-specific survival (LCSS) between the two groups. The data set was split into modelling and validation groups in a ratio of 7.5:2.5, and model risk predictors of postoperative death in elderly patients with NSCLC were screened using univariate and multifactorial logistic regression. Columnar plots were constructed for model visualisation, and the area under the subject operating characteristic curve (AUC), DCA decision curve and clinical impact curve were used to assess model predictiveness and clinical utility.

Results

Multi-factor logistic regression results showed that sex, age, race, histology and grade were independent predictors of the risk of postoperative death in elderly patients with NSCLC. The above factors were imported into R software to construct a line graph model for predicting the risk of postoperative death in elderly patients with NSCLC. The AUCs of the modelling and validation groups were 0.711 and 0.713 respectively, indicating that the model performed well in terms of predictive performance. The DCA decision curve and clinical impact curve showed that the model had a high net clinical benefit and was of clinical application.

Conclusion

The construction and validation of a predictive model for death within 90 days of lobectomy in elderly patients with lung cancer will help the clinic to identify high-risk groups and give timely intervention or adjust treatment decisions.

Association of geriatric nutritional risk index with all-cause hospital mortality among elderly patients in intensive care unit

Background

Malnutrition is associated with poor outcomes for geriatric patients in intensive care unit (ICU). It is important to identify patients at risk of malnutrition and provide individual nutrition support. The assessment of malnutrition risk is not easy for these patients due to their cognitive impairment. Geriatric nutrition risk index (GNRI) is a simple and objective scoring tool to evaluate the risk of malnutrition in elderly patients. In this study, we aimed to see whether GNRI score was appropriate to predict clinical outcomes among geriatric patients in the setting of ICU.

Materials and methods

Elderly patients with age ≥ 65 years were extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Categories based on GNRI were classified as major risk (GNRI <82), moderate risk (GNRI 82 to <92), low risk (GNRI 92 to ≤98), and no risk (GNRI >98). The primary outcome was all-cause hospital mortality. Multivariable Cox proportional hazards regression models and restricted cubic spline were used to investigate associations of GNRI with hospital mortality, respectively. A two-piecewise linear regression model was applied to examine the inflection point of GNRI on hospital mortality. To reduce selection bias, propensity score matching (PSM) was used in a 1:1 ratio.

Results

A total of 3,696 geriatric patients were finally included with median age 75 (69, 81) years. The prevalence of major risk was 28.6%. In the fully adjusted model, GNRI categories featured a negative trend with hospital mortality (p for trend = 0.037). Restricted cubic spline analysis demonstrated an L-shaped relationship between GNRI and hospital mortality before and after matching. The inflection point was 78.7. At the left side of inflection point, GNRI levels were significantly negatively associated with hospital mortality (HR = 0.96, 95% CI: 0.94-0.98; p < 0.001) and featured no significant relations at the right side. Multiple linear regression also showed that GNRI was negatively associated with length of stay in hospital.

Conclusion

The major risk of malnutrition defined by GNRI was able to predict poor prognosis for geriatric patients admitted to ICU.

Geriatric Nutritional Risk Index and the Prognosis of Patients with Stroke: A Meta-Analysis

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.

Nutrition therapy in the older critically ill patients: A scoping review

Introduction: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. Method: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied. Results: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia. Conclusion: Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion. Keywords: Critical care nutrition, geriatric patients, intensive care medicine, older adults, scoping review

Geriatric Nutritional Risk Index as a Prognostic Factor of Patients with Non-Small Cell Lung Cancer: A Meta-Analysis

Geriatric nutritional risk index (GNRI), a newly developed indicator of nutritional status retrieved by serum albumin concentration and ideal body weight, has been suggested as a prognostic factor for various malignancies. The aim of the study was to summarize the prognostic role of GNRI for patients with non-small cell lung cancer (NSCLC) in a meta-analysis. Cohort studies evaluating the relationship between GNRI at baseline and survival OF NSCLC were retrieved by search of PubMed, Embase, and Web of Science databases from inception to January 12, 2022. A conservative random-effect model incorporating the possible influence of between-study heterogeneity was used to pool the results. Eleven cohorts including 2865 patients with NSCLC were included. Compared to those with higher GNRI, NSCLC patients with lower GNRI were associated with poorer overall survival [OS, hazard ratio (HR): 2.39, 95% CI: 1.97-2.91, p<0.001; I2=29%), progression-free survival (HR: 1.94, 95% CI: 1.52-2.47, p<0.001; I2=29%), and cancer-specific survival (HR: 2.59, 95% CI: 1.55-4.35, p<0.001; I2=0%). Subgroup analyses showed that the significant association between lower GNRI and worse OS in patients with NSCLC was not affected by study characteristics including study location, design, cancer stage, treatment, or follow-up durations (p for subgroup effects all<0.001). In conclusion, a lower GNRI in patients with NSCLC may be a predictor of poor survival. Nutritional status indicated by GNRI may be important for the prognostic prediction of patients with NSCLC.

Geriatric Nutritional Risk Index and Survival of Patients With Colorectal Cancer: A Meta-Analysis

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.