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Huang H, Fu B, Long T, Yu Y, Cheng S, Gu M, Cai C, Chen X, Niu H, Hua W. Implication of geriatric nutritional risk index on treatment response and long-term prognosis in patients with cardiac resynchronization therapy. Int J Cardiol 2024:132064. [PMID: 38670460 DOI: 10.1016/j.ijcard.2024.132064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing the nutritional status of the aging population. This study aims to explore the clinical implication of GNRI on treatment response and long-term clinical outcomes in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). METHODS Patients who underwent CRT implantation or upgrade at our hospital were retrospectively included. The association of GNRI and its tertiles with the echocardiographic response, all-cause mortality or heart transplantation, and the first hospitalization due to HF were investigated. RESULTS Totally, 647 patients were enrolled, with a median age of 60 [Interquartile Range (IQR): 52-67] years and mean score of GNRI at 107.9 ± 23.7. Super-response rates increased significantly among the GNRI T1, T2, and T3 groups (25.1%, 29.8% vs. 41.1%, P = 0.002). Patients with higher GNRI were more likely to have better LVEF improvement after multiple adjustments (OR = 1.13, 95% CI: 1.04-1.23, P = 0.010). Higher GNRI was independently associated with a lower risk of all-cause mortality or heart implantation (HR = 0.95, 95% CI: 0.93-0.96, P < 0.001) and HF hospitalization (HR = 0.96, 95% CI: 0.95-0.98, P < 0.001). The inclusion of GNRI enhanced the predictability of all-cause mortality based on traditional model, including sex, New York Heart Association functional class, left bundle branch block, QRS reduction, and N-terminal pro-B-type natriuretic peptide level (C statistics improved from 0.785 to 0.813, P = 0.007). CONCLUSION Higher GNRI was associated with better treatment response and long-term prognosis in HF patients with CRT. Evaluation of nutritional status among CRT population is necessary for individualized choice of potential responders.
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Affiliation(s)
- Hao Huang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqi Fu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianxin Long
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sijing Cheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuhua Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 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. Eur J Surg Oncol 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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Pan J, Xu G, Zhai Z, Sun J, Wang Q, Huang X, Guo Y, Lu Q, Mo J, Nong Y, Huang J, Lu W. Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study. Clin Nutr 2024; 43:1125-1135. [PMID: 38583354 DOI: 10.1016/j.clnu.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND & AIMS The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM. METHODS A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72-94.56, n = 194), moderate-level (94.56-100.22, n = 193), and high-level (100.22-116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan-Meier survival analysis. RESULTS Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P < 0.001) and bone mineral density (BMD) [lumbar spine (LS), r = 0.088, P = 0.034; femoral neck (FN), r = 0.167, P < 0.001; total hip (TH), r = 0.171, P < 0.001]; negatively correlated with MOF (r = -0.105, P = 0.012) and HF (r = -0.154, P < 0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P < 0.001) and was Z-shaped with the 10-year MOF (P = 0.03) and HF (P = 0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR) = 1.950; 95% confidence interval (CI) = 1.076-3.535; P = 0.028] and low-level (HR = 2.538; 95% CI = 1.378-4.672; P = 0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction > 0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P < 0.05). Kaplan-Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P < 0.001). CONCLUSION This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.
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Affiliation(s)
- Jiangmei Pan
- Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, People's Republic of China; Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Guoling Xu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jingxia Sun
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Qiu Wang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiuxian Huang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Yanli Guo
- Changzhi Medical College, Changzhi, Shanxi, 046000, People's Republic of China
| | - Quan Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jianming Mo
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Yuechou Nong
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
| | - Jianhao Huang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
| | - Wensheng Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
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Yu W, Wang H, Li M, Yang F, Bai J, Song H, Huang X. Prognostic value of geriatric nutritional risk index in patients with amyotrophic lateral sclerosis. J Clin Neurosci 2024; 122:19-24. [PMID: 38432041 DOI: 10.1016/j.jocn.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/13/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The geriatric nutritional risk index (GNRI) is a prognostic indicator for several diseases, meanwhile, nutrition and inflammation play important roles in the disease progression of amyotrophic lateral sclerosis (ALS). However, the association between the GNRI and ALS remains unknown. METHODS 443 patients diagnosed with ALS were divided into two groups based on the GNRI levels. Associations between GNRI and survival time were analyzed using Kaplan-Meier curves and compared by the log-rank test. Univariate and multivariate analyses were used to assess their prognostic values for survival time. Spearman correlation analysis was used to evaluate the correlation coefficients between GNRI and other clinical variables. RESULTS No significant differences were found in diagnostic delay between the two groups. The onset age and disease progression rate (DPR) were significantly lower in high GNRI group while forced vital capacity (FVC), revised version of the ALS functional rating scale (ALSFRS-R), serum albumin and body mass index (BMI) were significantly lower in low GNRI group. Lower GNRI levels were linked with shorter ALS patients' survival time by Kaplan-Meier curves. The univariate and multivariate analysis identified the onset age, gender, onset site, diagnostic delay, DRP and GNRI as predictors of survival time in patients with ALS. CONCLUSION Nutritional status was closely corelated with ALS progression. The GNRI may be used as a potential prognostic indictor for ALS patients.
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Affiliation(s)
- Wenxiu Yu
- Medical School of Chinese PLA, Beijing 100853, China; Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Hongfen Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Mao Li
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fei Yang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiongming Bai
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; College of Medicine, Nankai University, Tianjin 300071, China
| | - Han Song
- Department of Health Service, Chinese PLA General Hospital, Beijing 100853, China.
| | - Xusheng Huang
- Medical School of Chinese PLA, Beijing 100853, China; Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
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Chen Q, Zhu C, Ai Y, Wang J, Ding H, Luo D, Li Z, Song Y, Feng G, Liu L. Preoperative geriatric nutritional risk index is useful factor for predicting postoperative delirium among elderly patients with degenerative lumbar diseases. Eur Spine J 2024; 33:1055-1060. [PMID: 38341814 DOI: 10.1007/s00586-024-08142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE It is the first study to evaluate the predictive value of the geriatric nutritional risk index (GNRI) on postoperative delirium (POD) after transforaminal lumber interbody fusion (TLIF) in elderly patients with degenerative lumbar diseases. METHODS A retrospective study was conducted to assess the outcomes of TLIF surgery in elderly patients with lumbar degenerative disease between the years 2016 and 2022. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, utilizing the Confusion Assessment Method. The geriatric nutritional risk index was calculated using the baseline serum albumin level and body weight. Multivariate logistic regression analysis was employed to identify the association between preoperative GNRI and postoperative delirium (POD). Additionally, a receiver operating characteristic curve was utilized to determine the optimal GNRI cutoff for predicting POD. RESULTS POD was observed in 50 of the 324 patients. The GNRI was visibly reduced in the delirium group. The mean GNRI was 93.0 ± 9.1 in non-delirium group and 101.2 ± 8.2 in delirium group. On multivariate logistic regression, Risk of POD increases significantly with low GNRI and was an independent factor in predicting POD following TLIF (OR 0.714; 95% CI 0.540-0.944; p = 0.018). On receiver operating characteristic curve, the area under curve (AUC) for GNRI was 0.738 (95% CI 0.660-0.817). The cutoff value for GNRI according to the Youden index was 96.370 (sensitivity: 66.0%, specificity: 70.4%). CONCLUSION Our study indicated that lower GNRI correlated significantly with POD after TLIF. Performing GNRI evaluation prior to TLIF may be an effective approach of predicting the risk for POD among elderly patients with degenerative lumbar diseases.
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Affiliation(s)
- Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dun Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zheng Li
- Department of Neurosurgery, Hokkaido University, Sapporo, Japan
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Wei F, Cheng H, He R, Yang X, Hu Z, Lyu J, Wang Y. Geriatric nutritional risk index independently predicts delirium in older patients in intensive care units: A multicenter cohort study. Arch Gerontol Geriatr 2024; 118:105288. [PMID: 38056103 DOI: 10.1016/j.archger.2023.105288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Malnutrition is associated with clinical outcomes in several diseases. However, the role of malnutrition in the risk of delirium in elderly patients in intensive care units (ICU) remains unclear. This study aimed to elucidate the association between the Geriatric Nutritional Risk Index (GNRI) and the risk of delirium in elderly patients in the ICU. METHODS Elderly patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD) were included in this study, totaling 11,310 and 5,627, respectively. All subjects were stratified according to their GNRI score: those with no nutritional risk (GNRI > 98), mild nutritional risk (92 ≤ GNRI ≤ 98), moderate nutritional risk (82 ≤ GNRI ≤ 92), and severe nutritional risk (GNRI < 82). The primary outcome was delirium. RESULTS The GNRI in MIMIC-IV and eICU-CRD were 93.82 (84.88, 101.26) and 83.39 (75.95, 89.35), respectively. Compared to the cohort without nutritional risk, there was an increased risk of delirium in patients with mild nutritional risk (OR: 1.39, 95 % CI: 1.23-1.58), moderate nutritional risk (OR: 1.72, 95 % CI: 1.52-1.95), and severe nutritional risk (OR: 2.07, 95 % CI: 1.79-2.39). Inclusion of the GNRI score in the multivariate models improved the prediction of delirium. Similar results were found in the eICU-CRD database. CONCLUSIONS Nutritional assessment using the GNRI may be an independent predictor of the development of delirium in elderly patients in the ICU. The addition of the GNRI score to the delirium prediction model improves its predictive accuracy.
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Affiliation(s)
- Fangxin Wei
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ruiyao He
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ziqi Hu
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China; Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Yu Wang
- The Community Service Center of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Tchilikidi KY. Actuality and underlying mechanisms of systemic immune-inflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma. World J Gastrointest Surg 2024; 16:260-265. [PMID: 38463345 PMCID: PMC10921210 DOI: 10.4240/wjgs.v16.i2.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/26/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
This editorial contains comments on the article "Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer" in a recent issue of the World Journal of Gastrointestinal Surgery. It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immune-inflammation index (SII) and geriatric nutritional risk index (GNRI) prediction features valuable. There are few publications on both SII and GNRI together in hepatocellular carcinoma (HCC) and patient prognosis after radical surgery. Neutrophils release cytokines, chemokines, and enzymes, degrade extracellular matrix, reduce cell adhesion, and create conditions for tumor cell invasion. Neutrophils promote the adhesion of tumor cells to endothelial cells, through physical anchoring. That results in the migration of tumor cells. Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs. Platelets can form a protective film on the surface of tumor cells. This allows avoiding blood flow damage as well as immune system attack. It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness. High SII is also associated with macro- and microvascular invasion and increased numbers of circulating tumor cells. A high GNRI was associated with significantly better progression-free and overall survival. HCC patients are a very special population that requires increased attention. SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings. The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features. Those features provide tumor nutrition, growth, and distribution throughout the body, such as vascular invasion. On the other hand, they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings. The article is of considerable interest. It would be helpful to continue the study follow-up to 2 years and longer. External validation of the data is needed.
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Affiliation(s)
- Konstantin Y Tchilikidi
- Department of Surgery with Postgraduate Education, Altai State Medical University, Barnaul 656031, Russia
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Li Z, Zhang L, Yang Q, Zhou X, Yang M, Zhang Y, Li Y. Association between geriatric nutritional risk index and depression prevalence in the elderly population in NHANES. BMC Public Health 2024; 24:469. [PMID: 38355455 PMCID: PMC10868080 DOI: 10.1186/s12889-024-17925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The prevalence of depression is increasing in the elderly population, and growing evidence suggests that malnutrition impacts mental health. Despites, research on the factors that predict depression is limited. METHODS We included 2946 elderly individuals from National Health and Nutrition Examination Survey (NHANES) spanning the years 2011 through 2014. Depressive symptoms were assessed using the PHQ-9 scale. Multinomial logistic regression was performed to evaluate the independent association between Geriatric Nutritional Risk Index (GNRI) and depression prevalence and scores. Subgroup analysis was conducted to explore potential factors influencing the negative correlation between GNRI and depression. Restricted cubic spline graph was employed to examine the presence of a non-linear relationship between GNRI and depression. RESULTS The depression group had a significantly lower GNRI than the non-depression group, and multivariate logistic regression showed that GNRI was a significant predictor of depression (P < 0.001). Subgroup analysis revealed that certain demographic characteristics were associated with a lower incidence of depression in individuals affected by GNRIs. These characteristics included being female (P < 0.0001), non-Hispanic black (P = 0.0003), having a moderate BMI (P = 0.0005), having a college or associates (AA) degree (P = 0.0003), being married (P = 0.0001), having a PIR between 1.50 and 3.49 (P = 0.0002), being a former smoker (P = 0.0002), and having no history of cardiovascular disease (P < 0.0001), hypertension (P < 0.0001), and diabetes (P = 0.0027). Additionally, a non-linear negative correlation (non-linear P < 0.01) was found between GNRI and depression prevalence, with a threshold identified at GNRI = 104.17814. CONCLUSION The GNRI demonstrates efficacy as a reliable indicator for forecasting depression in the elderly population. It exhibits a negative nonlinear correlation with the prevalence of depression among geriatric individuals.
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Affiliation(s)
- Zijiao Li
- Nephrology department of the First Affiliated Hospital of Army Medical University, 400038, Chongqing, China
| | - Li Zhang
- Department of Neurosurgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Qiankun Yang
- National & Regional United Engineering Lab of Tissue Engineering, Department of Orthopedics, Southwest Hospital, Army Medical University, 400038, Chongqing, China
| | - Xiang Zhou
- Nephrology department of the First Affiliated Hospital of Army Medical University, 400038, Chongqing, China
| | - Meng Yang
- Nephrology department of the First Affiliated Hospital of Army Medical University, 400038, Chongqing, China
| | - Yu Zhang
- Department of Dermatology, The Second Affiliated Hospital of Chongqing Medical University, 400010, Chongqing, China.
| | - Youzan Li
- Nephrology department of the First Affiliated Hospital of Army Medical University, 400038, Chongqing, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang P, Cui H, Wang Z, Yuan P, Liu Y, Xu Z. The Association of nutritional status and physical activity on osteoporotic refractures among older adults. Geriatr Nurs 2024; 55:130-135. [PMID: 37988958 DOI: 10.1016/j.gerinurse.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND This paper focuses on revealing the relationship between the Geriatric Nutritional Risk Index (GNRI) and Activity of Daily Living (ADL) with osteoporotic refracture. METHODS Data from 1068 inpatients with osteoporotic fractures were analyzed. Binary logistic regression, Cox proportional hazard regression and Kaplan-Meier curves were performed for osteoporosis characteristics and its risk factors. Receiver operating characteristic (ROC) curve was developed to predict the cut-off value. RESULTS The study showed that older age, lower ADL and lower GNRI were independent risk factors for osteoporotic fracture with OR of 1.039, 0.946, 0.892 and HR of 1.033, 0.967, 0.947 respectively. According to the results of ROC, the predictive accuracy of GNRI was high with an area under ROC (AUC) of 0.715, sensitivity of 76.6%, specificity of 53.5% and a threshold value of 99.65. CONCLUSION Older age, lower ADL and lower GNRI were independent risk factors for osteoporotic refracture.
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Affiliation(s)
- Peng Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Hao Cui
- Department of Orthopedics, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Zhenting Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Peng Yuan
- Department of Rehabilitation Medicine, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Yi Liu
- Department of Orthopedics, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China.
| | - Zhujie Xu
- Department of Orthopedics, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, 214023, China; Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, 214000, China.
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Shih YL, Chuang HC, Lin YT, Chien CY, Yang CH, Lai CC, Su YY, Tsai YT, Lu H, Tsai MH. The prognostic utility of preoperative geriatric nutritional risk index on survival outcomes of locally advanced oral cancer. J Formos Med Assoc 2023; 122:1296-1304. [PMID: 37433711 DOI: 10.1016/j.jfma.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE This retrospective cohort study was to assess the prognostic value of preoperative geriatric nutritional risk index (GNRI) on survival outcomes for patients with locally advanced oral squamous cell carcinoma (LAOSCC). METHODS Patients with LAOSCC receiving upfront radical surgery at a single institute from January 2007 to February 2017 were enrolled. The primary outcomes in the study were 5-year overall survival (OS) and cancer-specific survival (CSS) rates, and a nomogram based on GNRI and other clinical-pathological factors was established for individualized OS prediction. RESULTS There were 343 patients enrolled in this study. The optimal cut-off value of GNRI was observed to be 97.8. Patients in the high-GNRI group (GNRI ≥97.8) had statistically significantly better outcomes in 5-year OS (74.7% vs. 57.2%, p = 0.001) and CSS (82.2% vs. 68.9%, p = 0.005) when compared with the low-GNRI group (GNRI <97.8). In Cox models, low GNRI remained an independent negative prognosticator of OS (HR: 1.6; 95% CI: 1.124-2.277; p = 0.009) and CSS (HR: 1.907; 95% CI: 1.219-2.984; p = 0.005). The c-index of the proposed nomogram, incorporating assorted clinicopathological factors and GNRI, had a statistically significant increase compared with the predictive nomogram constructed by the TNM staging system alone (0.692 vs. 0.637, p < 0.001)." CONCLUSION Preoperative GNRI is an independent prognostic factor of OS and CSS in patients with LAOSCC. A multivariate nomogram that includes GNRI may better help us to accurately estimate individual survival outcomes.
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Affiliation(s)
- Yi-Lun Shih
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ching Chuang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Tsai Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Hui Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Chih Lai
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yan-Ye Su
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology, ChiaYi Chang Gung Memorial Hospital, ChiaYi, Taiwan
| | - Hui Lu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Hsien Tsai
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wu P, Liu J, Wang X, Lai S, Wang J, Wang J, Wang J, Zhang Y, Hao Q. Development and validation of a nomogram based on geriatric nutritional risk index for predicting prognosis and postoperative complications in surgical patients with upper urinary tract urothelial carcinoma. J Cancer Res Clin Oncol 2023; 149:18185-18200. [PMID: 38032382 DOI: 10.1007/s00432-023-05462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the potential role of the Geriatric Nutritional Risk Index (GNRI) in predicting oncological outcomes and postoperative complications in UTUC patients undergoing radical nephroureterectomy (RNU) and to develop a nomogram incorporating GNRI to predict outcomes. METHODS A retrospective analysis was performed on 458 consecutive patients who underwent RNU in our center. According to nutritional scores, patients were divided into the following groups: low GNRI (GNRI ≤ 98) and high GNRI (GNRI > 98). Univariable and multivariable logistic regression were performed to investigate the role of GNRI in predicting the perioperative complications. The survival was compared with Kaplan - Meier curve, and test by log-rank tests. Risk factors associated with cancer-specific survival (CSS) and overall survival (OS) were evaluated using Cox proportional hazards regression model and were integrated into a nomogram for individualized risk prediction. The calibration and discrimination ability of the model were evaluated by concordance index (C-index) and risk group stratification. RESULTS When compared with high GNRI, low GNRI had significantly lower survival (CSS, p < 0.001; OS, p < 0.001). Across all patients, multivariable analyses revealed that low GNRI was an independent prognostic factor (CSS, p = 0.007; OS, p = 0.005). Nomograms for 1-, 3-, and 5 years of CSS and OS had good performance. Patients can be stratified into different groups based on the nomogram, with significant differences in OS and CSS. Further, GNRI was also found to be an independent risk factor for postoperative complications. The complication - prediction nomogram based on GNRI was also internally validated and showed good performance. CONCLUSIONS The GNRI score is an independent predictor for the prognosis and postoperative complications of UTUC following RNU. This study presented a nomogram incorporating preoperative GNRI that might be used as a convenient tool to facilitate the preoperative individualized prediction of short- and long-term outcomes for patients with UTUC.
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Affiliation(s)
- Pengjie Wu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Jianyong Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Xinhao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
- Fifth School of Clinical Medicine, Peking University, Beijing, China
| | - Shicong Lai
- Department of Urology, Peking University People's Hospital, Beijing, 100044, People's Republic of China
| | - Jiawen Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Jianlong Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
- Beijing Hospital Continence Center, Beijing, People's Republic of China.
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
- Beijing Hospital Continence Center, Beijing, People's Republic of China.
| | - Qiang Hao
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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Oakley CT, Konopka JA, Rajahraman V, Barzideh OS, Meftah M, Schwarzkopf R. Does the geriatric nutritional risk index predict complication rates and implant survivorship in revision total joint arthroplasty? Arch Orthop Trauma Surg 2023; 143:7205-7212. [PMID: 37442825 DOI: 10.1007/s00402-023-04987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Malnutrition is associated with poorer outcomes after revision total joint arthroplasty (rTJA), though no universal metric for assessing malnutrition in rTJA patients has been reported. This study sought to determine if malnutrition as defined by the Geriatric Nutritional Risk Index (GNRI) can independently predict short-term complication rates and re-revision risk in patients undergoing rTJA. METHODS All patients ≥ 65 years old undergoing rTJA from 2011 to 2021 at a single orthopaedic specialty hospital were identified. Preoperative albumin, height, and weight were used to calculate GNRI. Based on the calculated GNRI value, patients were stratified into three groups: normal nutrition (GNRI > 98), moderate malnutrition (GNRI 92-98), and severe malnutrition (GNRI < 92). Chi-squared and independent samples t-tests were used to compare groups. RESULTS A total of 531 rTJA patients were included. Patients with normal nutrition were younger (p < 0.001), had higher BMI (p < 0.001). After adjusting for baseline characteristics, patients with severe and moderate malnutrition had longer length of stay (p < 0.001), were less likely to be discharged home (p = 0.049), and had higher 90-day major complication (p = 0.02) and readmission (p = 0.005) rates than those with normal nutrition. 90-day revision rates were similar. In Kaplan-Meier analyses, patients with severe and moderate malnutrition had worse survivorship free of all-cause re-revision at 1-year (p = 0.001) and 2-year (p = 0.002) follow-up compared to those with normal nutrition. CONCLUSION Moderate and severe malnutrition, as defined by GNRI, independently predicted higher complication and revision rates in rTJA patients. This suggests that the GNRI may serve as an effective screening tool for nutritional status in patients undergoing rTJA.
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Affiliation(s)
- Christian T Oakley
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Jaclyn A Konopka
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Vinaya Rajahraman
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Omid S Barzideh
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Morteza Meftah
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
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Shi T, Wang Y, Peng Y, Wang M, Zhou Y, Gu W, Li Y, Zou J, Zhu N, Chen L. Advanced lung cancer inflammation index combined with geriatric nutritional risk index predict all-cause mortality in heart failure patients. BMC Cardiovasc Disord 2023; 23:565. [PMID: 37978441 PMCID: PMC10655430 DOI: 10.1186/s12872-023-03608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND This study was undertaken to explore the predictive value of the advanced lung cancer inflammation index (ALI) combined with the geriatric nutritional risk index (GNRI) for all-cause mortality in patients with heart failure (HF). METHODS AND RESULTS We enrolled 1123 patients with HF admitted to our cardiology department from January 2017 to October 2021. Patients were divided into four groups, according to the median ALI and GNRI. From the analysis of the relationship between the ALI and GNRI, we concluded that there was a mild positive linear correlation (r = 0.348, p < 0.001) and no interaction (p = 0.140) between the ALI and GNRI. Kaplan‒Meier analysis showed that the cumulative incidence of all-cause mortality in patients with HF was highest in Group 1 (log-rank χ2 126.244, p < 0.001). Multivariate Cox proportional hazards analysis revealed that ALI and GNRI were independent predictors of all-cause mortality in HF patients (ALI: HR 0.407, 95% CI 0.296-0.560, p < 0.001; GNRI: HR 0.967, 95% CI 0.954-0.980, p < 0.001). The area under the curve (AUC) for ALI combined with GNRI was 0.711 (p < 0.001), according to the time-dependent ROC curve. CONCLUSION ALI and GNRI were independent predictors of all-cause mortality in HF patients. Patients with HF had the highest risk of all-cause mortality when the ALI was < 24.60 and the GNRI was < 94.41. ALI combined with the GNRI has good predictive value for the prognosis of HF patients.
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Affiliation(s)
- Tao Shi
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Wang
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunzhu Peng
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Yanji Zhou
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenyi Gu
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanyan Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jie Zou
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Na Zhu
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lixing Chen
- The First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Kaneko T, Nakamura S, Hayakawa K, Tokimura F, Miyazaki T. Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty. Eur J Orthop Surg Traumatol 2023; 33:2859-2864. [PMID: 36871251 DOI: 10.1007/s00590-023-03508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Preoperative deep vein thrombosis (DVT) is a risk factor for postoperative venous thromboembolism (VTE), causing severe mortality. Early detection of preoperative DVT is essential to prevent postoperative VTE. However, little is known regarding preoperative DVT in patients undergoing major surgery. The present study aimed to determine the incidence and risk factors of preoperative DVT in patients admitted for total hip arthroplasty (THA). METHODS From August 2017 to September 2022, 243 patients admitted for THA at our institution were enrolled in this study. Patients medical records and preoperative laboratory data were retrospectively collected. According to the results of lower-limb ultrasonography, patients were divided into either the non-DVT (n = 136) or DVT (n = 43) group. The incidence of DVT and independent risk factors for preoperative DVT were investigated using univariate and multivariate logistic regression analyses. RESULTS The mean age was 74.0 ± 8.4 years. Preoperative DVT was diagnosed in 43 of the 243 (17.7%) patients. The risk of DVT was significantly high (p < 0.05) in patients with advanced age, increased D-dimer levels, and malnutrition status, as assessed by the Geriatric Nutritional Risk Index (GNRI). Multivariate analysis showed that advanced age, increased D-dimer level, and malnutrition status assessed by the GNRI were independent risk factors for preoperative DVT. CONCLUSION A high incidence of preoperative DVT was observed in patients undergoing THA. Advanced age, increased D-dimer levels, and malnutrition assessed by the GNRI increased the risk of preoperative DVT. Screening high-risk subgroups for preoperative DVT is necessary to prevent postoperative VTE.
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Affiliation(s)
- Taizo Kaneko
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan.
| | - Shinya Nakamura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
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Xing T, Xu Y, Li J, Wen L, Xu Q, Liang W, Liang P, Liu Y, Tan R, Liu Y, Zhong X. Associations between insulin-like growth factor-1 standard deviation score and overall nutritional parameters in patients with maintenance hemodialysis: a cross-sectional study. Int Urol Nephrol 2023; 55:2257-2266. [PMID: 36853448 DOI: 10.1007/s11255-023-03526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND This study investigated the association between insulin-like growth factor-1 and nutritional status indicators in patients undergoing maintenance hemodialysis (MHD). METHODS Patients undergoing MHD for > 3 months were included in this single-center cross-sectional study in March 2021. Clinical, demographic, and body mass data and blood samples were collected before the hemodialysis sessions. Serum insulin-like growth factor-1 (IGF-1) levels were measured using a radioimmunoassay, and serum IGF-1 standard deviation score (SDS) was calculated for MHD patients according to age and sex. The nutritional status of patients was assessed using serum albumin, serum prealbumin, handgrip strength, pinching strength, upper arm muscle circumference, lean body mass, phase angle, seven-point subjective global assessment (SGA) score, and geriatric nutritional risk index (GNRI). The patients were divided into groups according to tertiles of serum IGF-1 SDS levels. Spearman correlation analyses and univariate and multivariate binary logistic regression analyses were used to determine the association between serum IGF-1 SDS and nutritional status parameters. RESULTS A total of 155 MHD patients (male: female = 90:65) were enrolled in the study, with a median dialysis vintage of 28.0 (11.0, 55.0) months, and an average age of 66 (65.5 ± 13.0) years. The median of IGF-1 SDS was - 0.1 (- 0.6 to 0.6). Compared to patients with higher IGF-1 SDSs, patients with lower IGF-1 SDSs had lower levels of serum ceruloplasmin (341.0 [287.5, 416.0] vs 395.0 [327.0, 451.0] vs 409.0 [349.5, 507.5], p = 0.002), serum albumin (34.7 ± 3.0 vs 37.0 ± 3.1 vs 37.8 ± 2.6, p < 0.001), serum prealbumin (270.3 [233.7, 327.8] vs 326.0 [279.3, 355.6] vs 363.0 [324.2, 398.2], p < 0.001), handgrip strength (13.8 [10.0, 20.7] vs 17.7 [10.7, 22.5] vs 23.3 [16.6, 27.8], p < 0.001), pinch strength (4.6 [3.9, 6.0] vs 4.9 (3.9, 6.9) vs 6.5 [4.7, 8.7], p = 0.002), phase angle (3.3 [3.0, 3.8] vs 3.9 [3.4, 4.7] vs 4.3 [3.6, 5.2, p < 0.001), modified Creatinine Index (83.1 ± 19.7 vs 93.1 ± 23.4 vs 113.9 ± 24.3, p < 0.001), intracellular water (14.5 ± 4.4 vs 16.1 ± 4.9 vs 16.9 ± 4.4, p = 0.031), higher extracellular water (26.9 ± 5.8 vs 25.7 ± 5.5 vs 25.1 ± 3.1, p = 0.042), and higher malnutrition risk as defined by GNRI (49.0% vs 15.7% vs 11.5%, p < 0.001) and SGA (53.9% vs 23.5% vs 7.7%, p < 0.001). CONCLUSIONS Lower IGF-1 SDSs are independently associated with higher malnutrition risk in patients with MHD.
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Affiliation(s)
- Tingting Xing
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Yao Xu
- Department of Nephrology, The 2nd People's Hospital of Bijie, Bijie, Guizhou, People's Republic of China
| | - Jiaqi Li
- Department of Nephrology, South China Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Luona Wen
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, Guangdong, People's Republic of China
| | - Weifeng Liang
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Pan Liang
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Yun Liu
- Department of Nephrology, The 2nd People's Hospital of Bijie, Bijie, Guizhou, People's Republic of China.
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China.
| | - Rongshao Tan
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China.
| | - Yan Liu
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
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Jiao H, Wang L, Zhou X, Wu J, Li T. Prognostic Ability of Nutritional Indices for Outcomes of Bladder Cancer: A Systematic Review and Meta-Analysis. Urol Int 2023; 107:886-894. [PMID: 37643581 DOI: 10.1159/000531884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Nutrition has become an important parameter influencing the prognosis of several cancers. However, its impact on outcomes for bladder cancer (BC) is still unclear. This review examines the association between three commonly used nutritional indices, namely, the prognostic nutritional index (PNI), controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI) and outcomes of BC. METHODS PubMed, CENTRAL, Scopus, Web of Science, Embase, and Google Scholar were explored for studies published up to April 13, 2023. Data from studies were pooled to examine the association between PNI, CONUT, or GNRI and overall survival (OS) and recurrence-free survival (RFS). RESULTS Thirteen studies were included. Meta-analysis demonstrated significantly poor OS with low PNI versus high PNI in BC patients (hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.37, 2.14; I2 = 0%). This result remained significant in various subgroup analyses. However, no association was noted between PNI and RFS (HR: 1.22; 95% CI: 0.67, 2.24; I2 = 84%). Meta-analysis showed that patients with high CONUT scores had significantly poor OS (HR: 2.43; 95% CI: 1.82, 3.25; I2 = 0%) as well as RFS (HR: 2.90; 95% CI: 2.10, 4.01; I2 = 0%). Data on GNRI were scarce and conflicting. CONCLUSION Limited data show that PNI and CONUT are predictive of outcomes in BC. Low PNI was associated with poor OS, while high CONUT was associated with poor OS and RFS. Data on GNRI are too scarce to obtain conclusions. Further studies are needed to supplement the results.
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Affiliation(s)
- Huijie Jiao
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Lin Wang
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Xiaomei Zhou
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Jiacheng Wu
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Tiantian Li
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
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18
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Dong Y, Tao H, Liu L, Ni Z, Yang Z, Chen K, He S, Peng L, Chen X. The association between Geriatric Nutritional Risk Index and the risk of Invasive Candidiasis in critically ill older adults. BMC Infect Dis 2023; 23:530. [PMID: 37580651 PMCID: PMC10426167 DOI: 10.1186/s12879-023-08512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Invasive candidiasis is the most common hospital-acquired fungal infection in intensive care units (ICU). The Geriatric Nutritional Risk Index (GNRI) score was developed to evaluate the nutritional status of elderly adults. We aimed to assess the association between the GNRI score and the risk of invasive candidiasis in elderly patients admitted to ICU. METHODS Hospitalization information of elderly patients with invasive candidiasis was collected retrospectively from Medical Information Mart for Intensive Care (MIMIC) IV and MIMIC-III Clinical Database CareVue subset from 2001 to 2019. The main outcome of this study was the diagnosis of invasive candidiasis in patients. We employed a multivariable Cox regression and propensity score matching to balance the influence of confounding factors on the outcome. Furthermore, we conducted sensitivity analyses by categorizing the GNRI into classes based on thresholds of 98, 92, and 81. RESULTS A total of 6739 patients were included in the study, among whom 134 individuals (2%) were diagnosed with invasive candidiasis. The GNRI scores of patients with invasive candidiasis upon admission to the ICU were significantly lower, measuring 88.67 [79.26-98.27], compared to the control group with a score of 99.36 [87.98-110.45] (P < 0.001). The results of the multivariable Cox regression analysis demonstrated a strong association between higher GNRI scores and a decreased risk of invasive candidiasis infection (HR: 0.98, 95% CI: 0.97-0.99, P = 0.002). Consistently, similar results were obtained when analyzing the propensity score-matched cohort (HR: 0.99, 95% CI: 0.98-1, P = 0.028). Sensitivity analyses further confirmed a significantly increased risk of invasive candidiasis infection with lower GNRI scores. Specifically, the following associations were observed: GNRI ≤ 98 (HR: 1.83, 95% CI: 1.23-2.72, P = 0.003), GNRI ≤ 92 (HR: 1.68, 95% CI: 1.17-2.4, P = 0.005), 82 ≤ GNRI ≤ 92 (HR: 1.63, 95% CI: 1.01-2.64, P = 0.046), GNRI ≤ 81 (HR: 2.31, 95% CI: 1.44-3.69, P < 0.001). CONCLUSIONS Lower GNRI score was significantly associated with an increased risk of invasive candidiasis in elderly patients in ICU. Further research is needed to validate whether improving nutrition can prevent invasive candidiasis.
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Affiliation(s)
- Yongqiang Dong
- Deartment of Thyroid Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Heqing Tao
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China
| | - Ligang Liu
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, USA
| | - Ziyan Ni
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China
| | - Zhandong Yang
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China
| | - Kequan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China
| | - Shuying He
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China
| | - Liang Peng
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China.
| | - Xueqing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China.
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Sun T, Ma M, Huang X, Zhang B, Chen Z, Zhao Z, Zhou Y. Prognostic impacts of geriatric nutritional risk index in patients with ischemic heart failure after percutaneous coronary intervention. Clin Nutr 2023; 42:1260-1267. [PMID: 37343410 DOI: 10.1016/j.clnu.2023.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Malnutrition has been proven to be associated with increased risk of poor prognosis in a series of diseases. This study explored the association between poor nutritional status and prognosis in patients with ischemic heart failure (IHF) undergoing percutaneous coronary intervention (PCI). METHODS The study enrolled 1745 patients with IHF undergoing PCI. The mean follow-up time was 28.7 months. Nutritional status was assessed by geriatric nutritional risk index (GNRI). All patients were divided into four groups according to GNRI quartiles (median and interquartile range: 103.8, 99.9-107.7). The primary endpoint was major adverse cardiovascular events (MACE), and the secondary endpoints were each component of the primary endpoint as follows: all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. The Kaplan-Meier survival analyses were performed to evaluate the incidence of the endpoints among 4 groups. The multivariate Cox proportional hazards analysis confirmed the independent effect of GNRI on the primary endpoint and secondary endpoints. The restricted cubic spline (RCS) was performed to evaluate the non-linear association of GNRI with MACE. RESULT The negative correlation of the GNRI with MACE (Log-rank P < 0.001), all-cause mortality (Log-rank P < 0.001) and any revascularization (Log-rank P < 0.001) was confirmed through the Kaplan-Meier curves. Multivariate analysis showed that the decreased GNRI was independently related to increased risk of MACE (Quartile 1 versus Quartile 4: HR, 95% CI: 2.66, 2.01-3.51, P < 0.001), all-cause mortality (Quartile 1 versus Quartile 4: HR, 95% CI: 2.33, 1.54-3.50, P < 0.001) and any revascularization (Quartile 1 versus Quartile 4: HR, 95% CI: 3.42, 2.22-5.27, P < 0.001). In addition, the non-linear association of GNRI with MACE was shown through RCS and the risk of MACE decreased as the GNRI increased in general (Non-linear P < 0.001). CONCLUSION Decreased GNRI was an independent risk factor of MACE in IHF patients undergoing PCI.
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Affiliation(s)
- Tienan Sun
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Meishi Ma
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Xin Huang
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Biyang Zhang
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Zheng Chen
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Zehao Zhao
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Yujie Zhou
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China.
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Zhang X, Xiong Y, Xu A. [A Prognostic Model of Elderly Patients with Non-small Cell Lung Cancer
Based on Geriatric Nutritional Risk Index]. Zhongguo Fei Ai Za Zhi 2023; 26:497-506. [PMID: 37653013 PMCID: PMC10476213 DOI: 10.3779/j.issn.1009-3419.2023.106.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The relationship between nutritional status and prognosis of cancer patients has emerged as a hotspot for research. The aim of this study is to explore the application value of the geriatric nutritional risk index (GNRI) in assessing the prognosis of elderly patients with non-small cell lung cancer (NSCLC), and establish a Nomogram to predict the prognosis of elderly patients with NSCLC. METHODS The data of patients with NSCLC aged ≥65 years who were initially treated in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were retrospectively analyzed. To determine the optimal cut-off value for GNRI, receiver operating characteristic (ROC) curve was constructed, and the patients were divided into high and low GNRI groups. Kaplan-Meier curve and Log-rank test were used to compare overall survival (OS) of the two groups. Univariate and multivariate Cox regression was used to analyze the risk factors for poor prognosis in elderly patients with NSCLC. Nomogram predicting survival in elderly patients with NSCLC was constructed and validated by using R software. RESULTS Statistically significant differences in age, gender, body mass index (BMI), histological type, albumin, treatment methods, neutrophil to lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and cytokeratin 19 fragment (CYFRA21-1) were observed between the high and low GNRI groups (P<0.05). The Kaplan-Meier curve showed a shorter OS in the low-GNRI group. Multivariate Cox regression analysis showed that CYFRA21-1>3.3 ng/mL was an independent risk factor for the development of OS in patients with NSCLC, and GNRI>97.09 was a protective factor [hazard ratio (HR)=0.52, 95% confidence interval (CI): 0.34-0.79, P<0.05]. Patients in the stage IV had a 1.98-fold increased risk of death compared with patients in the stage I (95%CI: 1.02-3.86, P<0.05). The risk of death was 3.58 times higher in patients receiving chemotherapy alone compared with those receiving combination therapy (95%CI: 2.03-6.32, P<0.05). A Nomogram constructed on the basis of GNRI, which predicted the OS of elderly patients with NSCLC with a concordance index (C-index) of 0.70 (95%CI: 0.65-0.76), and the area under the curve (AUC) for 1 and 2-year survival rates to be 0.93 (95%CI: 0.87-0.98) and 0.72 (95%CI: 0.63-0.80), respectively, and the calibration curve has a good coincidence of prediction. CONCLUSIONS High GNRI scores are significantly associated with improved survival in elderly patients with NSCLC, and reliance on cut-off values may provide the appropriate timing for nutritional support. The Nomogram constructed in this study can be used as an effective tool to predict the survival rate of elderly patients with NSCLC, which has strong clinical practicability.
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Affiliation(s)
- Xiaonan Zhang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Yajun Xiong
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Aiguo Xu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
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Huo X, Wu M, Gao D, Zhou Y, Han X, Lai W, Wang M, Hang Y. Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in elderly hypertensive population: NHANES 1999-2016. Front Cardiovasc Med 2023; 10:1203130. [PMID: 37465450 PMCID: PMC10350498 DOI: 10.3389/fcvm.2023.1203130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background Hypertension is a major risk factor for the global burden of disease, and nutrition is associated with an increased risk of mortality from multiple diseases. Few studies have explored the association of nutritional risk with all-cause mortality and cardiovascular mortality in hypertension, and our study aims to fill this knowledge gap. Method We included data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 on a total of 10,037 elderly patients with hypertension. The nutritional status was evaluated using the Geriatric Nutrition Risk Index (GNRI). Kaplan-Meier survival analysis was performed to analyze the survival rates of different nutritional risk groups. COX proportional risk regression models were used to analyze the predictive effect of GNRI on all-cause mortality and cardiovascular mortality in hypertensive patients. Restricted cubic splines (RCS) were used to explore the nonlinear relationship between GNRI and mortality. Result The mean age of the hypertensive patients was 70.7 years. A total of 4255 (42.3%) all-cause mortality and 1207 (17.2%) cardiovascular mortality occurred during a median follow-up period of 106 months. Kaplan-Meier showed a more significant reduction in survival for the moderate to severe malnutrition risk of GNRI. The adjusted COX proportional hazards model showed that the hazard ratios for all-cause mortality and cardiovascular mortality in the moderate to severe malnutrition risk group for GNRI were 2.112 (95% CI, 1.377,3.240) and 2.604 (95% CI, 1.603,4.229), respectively. The RCS showed that increased GNRI was associated with a reduced risk of all-cause mortality and cardiovascular mortality risk reduction. Conclusion Malnutrition exposure assessed by GNRI effectively predicts the risk of all-cause mortality and cardiovascular mortality in the elderly with hypertension.
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Affiliation(s)
- Xuan Huo
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Meiyin Wu
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Dongmei Gao
- Department of Endocrinology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - YueShengzi Zhou
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Xu Han
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Weilin Lai
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Mengqi Wang
- Department of Cardiology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
| | - Yilun Hang
- Department of Medical Oncology, Zhejiang Medical and Health Group Hangzhou Hospital, Zhejiang, China
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Tsutsui T, Fujiwara T, Matsumoto Y, Kimura A, Kanahori M, Arisumi S, Oyamada A, Ohishi M, Ikuta K, Tsuchiya K, Tayama N, Tomari S, Miyahara H, Mae T, Hara T, Saito T, Arizono T, Kaji K, Mawatari T, Fujiwara M, Takasaki M, Shin K, Ninomiya K, Nakaie K, Antoku Y, Iwamoto Y, Nakashima Y. Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures. Osteoporos Int 2023:10.1007/s00198-023-06753-3. [PMID: 37067545 DOI: 10.1007/s00198-023-06753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20. BACKGROUND Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term. OBJECTIVE This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs. METHODS This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients' conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors. RESULTS The mean observation period was 4.0 years (range 0-7 years). The average age at the time of admission was 82 years (range 60-101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82-91), low risk (92-98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]). CONCLUSIONS We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.
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Affiliation(s)
- T Tsutsui
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - T Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Y Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - A Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - M Kanahori
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - S Arisumi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - A Oyamada
- Department of Orthopaedic Surgery, Saga Handicapped Children's Hospital, Saga, Japan
| | - M Ohishi
- Department of Orthopaedic Surgery, Chihaya Hospital, Fukuoka, Japan
| | - K Ikuta
- Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Saga, Japan
| | - K Tsuchiya
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Kyushu Hospital, Fukuoka, Japan
| | - N Tayama
- Department of Orthopaedic Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - S Tomari
- Department of Orthopaedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - H Miyahara
- Department of Orthopaedic Surgery, National Hospital Organization Kyushu Medical Centre, Fukuoka, Japan
| | - T Mae
- Department of Orthopaedic Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - T Hara
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Fukuoka, Japan
| | - T Saito
- Department of Orthopaedic Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - T Arizono
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - K Kaji
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - T Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - M Fujiwara
- Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, Japan
| | - M Takasaki
- Department of Orthopaedic Surgery, Harasanshin Hospital, Fukuoka, Japan
| | - K Shin
- Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan
| | - K Ninomiya
- Department of Orthopaedic Surgery, Koga Hospital 21, Fukuoka, Japan
| | - K Nakaie
- Department of Orthopaedic Surgery, National Hospital Organization Fukuoka-Higashi Medical Centre, Fukuoka, Japan
| | - Y Antoku
- Faculty of Medicine, Hospital Informatic Centre, Oita University, Oita, Japan
| | - Y Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Y Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Yıldırım F, Uzun O, Nasuhbeyoglu G, Narlioglu A, Deligöz Bildacı Y, Cavdar C, Deger SM. The Association between GNRI variability and mortality in peritoneal dialysis patients. Ther Apher Dial 2023. [PMID: 36938825 DOI: 10.1111/1744-9987.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The objective of this study is to examine the association between The Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population METHODS: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up. RESULTS GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (IQR, 91.9,108.9) (p<0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels [adjusted odds ratio (OR): 0.96, 95% confidence interval (CI): 0.93, 0.99, P = 0.04] and more profoundly GNRI variability [adjusted OR: 1.23, 95% CI: 1.01, 1.44, P = 0.03] were independently associated with mortality. CONCLUSION The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in PD patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Filiz Yıldırım
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Ozcan Uzun
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Guler Nasuhbeyoglu
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Aslihan Narlioglu
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Izmir, Turkey
| | - Yelda Deligöz Bildacı
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Caner Cavdar
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Serpil Muge Deger
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
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Badak TO, Ada S. Malnutrition: A risk factor for vascular access problems. J Vasc Access 2023:11297298231154631. [PMID: 36908020 DOI: 10.1177/11297298231154631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Vascular access problems are leading causes of morbidity, hospitalization, and impaired quality of life in chronic hemodialysis patients. Native arteriovenous fistula is the gold standard of vascular access. Geriatric nutritional risk index (GNRI), has recently been shown to be an easy and objective instrument for assessing nutritional status in these patient groups. Considering the association between arteria-venous fistula patency and inflammation, as well as the fact that inflammation is a component of malnutrition, the objective of this study was to determine the relation of malnutrition identified by GNRI with fistula patency. METHODS This is a single-center, retrospective, observational study. Hemodialysis patients with AVF were included in the research. Preoperative and postoperative GNRI values were computed and laboratory data were recorded. The patients were analyzed in two groups as the ones without thrombosis history (Group 1) and with thrombosis history (Group 2). According to GNRI, patients were investigated in four groups: G0 (non-risk group, >98), G1 (low risk, 92-98), G2 (moderate risk, 82-91), and G3 (high risk, 82). RESULTS Of the 331 patients, 60.1% (199) were male and the average age was 55 ± 15 years. Preoperative GNRI levels were significantly higher in group 1. In correlation analysis, patency time was positively correlated with preoperative GNRI values. Among the preoperative GNRI groups, the G3 group had a patency duration of 6 months (4.9-7.04), whereas the G0 group had a patency length of 37.59 (35.5-39.65) months. By linear regression analysis, preoperative GNRI and postoperative albumin level were determined to be the significant indicators of patency time. CONCLUSION GNRI a new tool for detecting malnutrition was strongly associated with fistula patency in hemodialysis patients. Detection of malnutrition before fistula operation may be helpful for the future follow up of the patients in terms of fistula patency.
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Affiliation(s)
- Tolga Onur Badak
- Department of Cardiovascular Surgery, Adana City Hospital, Adana, Turkey
| | - Sibel Ada
- Department of Nephrology, Prof. Dr. Cemil Tascioglu City Hospital, İstanbul, Turkey
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Imaoka Y, Ohira M, Kobayashi T, Honmyo N, Hamaoka M, Onoe T, Abe T, Oishi K, Inoue M, Ohdan H. Impact of Geriatric Nutritional Risk Index After Initial Hepatectomy for Hepatocellular Carcinoma: a Retrospective Cohort Study with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO). J Gastrointest Surg 2023:10.1007/s11605-023-05624-w. [PMID: 36869207 DOI: 10.1007/s11605-023-05624-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/11/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION The importance of a nutrition scoring system, including the geriatric nutritional risk index (GNRI), was reported as an objective tool widely used to assess nutritional status in patients with inflammatory disease, chronic heart failure, and chronic liver disease. However, studies on the relationship between GNRI and the prognosis in patients who have undergone initial hepatectomy have been limited. Thus, we conducted a multi-institutional cohort study to clarify the relationship between GNRI and long-term outcomes for hepatocellular carcinoma (HCC) patients after such a procedure. METHODS Data from 1,494 patients who underwent initial hepatectomy for HCC between 2009 and 2018 was retrospectively collected from a multi-institutional database. The patients were divided into two groups according to GNRI grade (cutoff: 92), and their clinicopathological characteristics and long-term results were compared. RESULTS Of the 1,494 patients, the low-risk group (≥ 92; N = 1,270) was defined as having a normal nutritional status. Meanwhile, low GNRI (< 92; N = 224) were divided into malnutrition as the high-risk group. Multivariate analysis identified seven prognostic factors of poor overall survival (higher tumor markers; α-fetoprotein (AFP) and des-γ-carboxy protein [DCP], higher ICG-R15 levels, larger tumor size, multiple tumors, vascular invasion, and lower GNRI and eight prognostic factors of high recurrence (HCV antibody positive, higher ICG-R15 levels, higher tumor markers such as AFP and DCP, greater bleeding, multiple tumors, vascular invasion, and lower GNRI). CONCLUSIONS In patients with HCC, preoperative GNRI predicts poorer overall survival and high recurrence.
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Affiliation(s)
- Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima University, Hiroshima, Japan. .,Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima University, Hiroshima, Japan
| | - Naruhiko Honmyo
- Department of Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Michinori Hamaoka
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Onoe
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure City, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Onomichi City, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Kure City, Japan
| | - Masashi Inoue
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima City, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima University, Hiroshima, Japan
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Noike R, Amano H, Hirano S, Tsubono M, Kojima Y, Oka Y, Aikawa H, Matsumoto S, Yabe T, Ikeda T. Combined assessment of frailty and nutritional status can be a prognostic indicator after percutaneous coronary intervention. Heart Vessels 2023; 38:332-9. [PMID: 36171443 DOI: 10.1007/s00380-022-02176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
The cardiac prognosis of patients with frailty and malnutrition remains poorly investigated. This study aimed to investigate the impact of frailty and malnutrition on cardiac prognosis by combining the clinical frailty scale (CFS) and the geriatric nutritional risk index (GNRI) in patients who underwent percutaneous coronary intervention (PCI). In this study, 608 patients who underwent PCI for stable angina pectoris between January 2018 and December 2020 were included. CFS scores of ≥ 4 were defined as high CFS and patients with these scores were considered frail. GNRI scores of ≤ 98.0 were defined as low GNRI and patients with these scores were considered to have malnutrition. Patients were categorized into low-risk (n = 267, low CFS and high GNRI), intermediate-risk (n = 200, high CFS or low GNRI), and high-risk (n = 141, high CFS and low GNRI) groups. Major adverse clinical events (MACEs), including all-cause death, nonfatal myocardial infarction, revascularization, hospitalization for heart failure, and stroke, were assessed. The median follow-up period was 529 days. During the follow-up, MACEs were found in 135 patients. The high-risk group were older (77.0 ± 9.2 vs 71.4 ± 10.7 vs 65.0 ± 10.1 years, p < 0.001), had higher prevalence rates of chronic kidney disease [61.7% (87/141) vs 37.5% (75/200) vs 16.9% (45/267); p < 0.001] and heart failure [47.5% (67/141) vs 22.5% (45/200) vs 12.4% (33/267), p < 0.001], and had higher C-reactive protein levels (1.64 ± 2.66 vs 1.00 ± 2.02 vs 0.34 ± 0.90 mg/dL; p < 0.001) than the intermediate-risk and low-risk groups. The high-risk group [hazard ratio (HR), 4.39; 95% confidence interval (CI), 2.87-6.72; p < 0.001] was an independent predictor of MACEs. In conclusion, patients with both frailty and malnutrition had a higher risk of MACEs after PCI than patients with frailty or malnutrition. Post-PCI patients should be evaluated for combined frailty and malnutrition.
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Takasawa E, Iizuka Y, Ishiwata S, Kakuta Y, Inomata K, Tomomatsu Y, Ito S, Honda A, Mieda T, Chikuda H. Impact of the preoperative nutritional status on postoperative kyphosis in geriatric patients undergoing cervical laminoplasty. Eur Spine J 2023; 32:374-81. [PMID: 36471185 DOI: 10.1007/s00586-022-07481-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to determine the association of preoperative malnutrition with an increased risk of cervical kyphosis after laminoplasty in geriatric patients with cervical spondylotic myelopathy (CSM). METHODS Geriatric patients who underwent cervical laminoplasty were included. Malnutrition was defined as a geriatric nutritional risk index < 98 before surgery. The C2-7 angle and the global alignment parameters were analyzed on standing radiographs. The postoperative kyphosis was defined as a C2-7 angle < 0° during a 2-year follow-up. RESULTS Ninety patients without preoperative kyphotic alignment were enrolled (mean age, 73.5 years old; 41.1% female). Twenty-one patients (23.3%) had malnutrition status (74.2 years old). Preoperatively, the global alignment parameters were comparable between the malnutrition and normal nutrition groups (SVA, 43.3 mm vs. 42.4 mm; T1S, 29.7° vs. 28.4°; TPA, 21.4° vs. 17.8°), with no significant difference in the C2-7 angle (15.1° vs. 15.2°). At 2 years postoperatively, the malnutrition group showed a significantly lower C2-7 angle than the normal nutrition group (9.3° vs. 15.8°, P = 0.03). Postoperative kyphosis was more prevalent in the malnutrition group (33.3% vs. 7.2%, P = 0.005). The preoperative nutritional status and C2-7 angle were independent predictors of postoperative kyphosis. The predictive C2-7 angles differed by preoperative nutritional status (malnutrition group, 11°; normal nutrition group, 7°). CONCLUSION Among geriatric CSM patients, preoperative malnutrition was closely associated with the increased occurrence of cervical kyphosis after laminoplasty. Our results underscore the importance of preoperative nutritional assessment and management in geriatric populations undergoing cervical spine surgery, as malnutrition is a perioperative modifiable risk factor.
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Takeuchi S, Kohno T, Goda A, Shiraishi Y, Saji M, Nagatomo Y, Tanaka TD, Takei M, Nakano S, Soejima K, Kohsaka S, Yoshikawa T. Malnutrition in real-world patients hospitalized for heart failure with preserved ejection fraction and its potential impact on generalizability of EMPEROR-Preserved trial. Int J Cardiol 2023; 370:263-270. [PMID: 36257476 DOI: 10.1016/j.ijcard.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the benefits of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin, its suitability for patients with heart failure (HF) in the real-world setting remains unclear. Considering the unique pharmacological profile of SGLT2i (e.g., glucose excretion leading to calorie loss) and increasingly aging patients with HF, applicability of trials' finding in patients with malnutrition is important. METHODS We examined 1633 consecutive patients with a preserved left ventricular ejection fraction (LVEF; >40%) enrolled in a multicenter-based acute HF registry. After applying the EMPEROR-Preserved eligibility criteria, we compared the baseline characteristics of trial-eligible and actual trial participants, and patients with and without malnutrition among the trial-eligible group. Malnutrition was assessed by the geriatric nutritional risk index (GNRI). The trial-eligible patients were divided into high (GNRI≥92) and low (GNRI<92) nutritional groups, and a composite endpoint comprising all-cause death and HF rehospitalization was evaluated. RESULTS Majority (70.2%) of the analyzed patients were eligible for the EMPEROR-Preserved trial (age: 77 ± 12 years and body mass index [BMI]: 22.0 ± 4.1 kg/m2), but were older and had lower BMIs than the actual trial participants. Notably, 51.9% of the eligible patients were at high risk for malnutrition and had a higher rate of the composite endpoint than non-malnourished counterparts (HR 1.27, 95%CI 1.04-1.56, P = 0.020). The difference in outcomes was predominantly due to mortality from non-cardiac causes. CONCLUSIONS Mostly patients with HF in a real-world setting met the EMPEROR-Preserved criteria; however, approximately half were at high risk for malnutrition with poorer outcomes owing to non-cardiac-related causes.
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Affiliation(s)
- Shinsuke Takeuchi
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | - Toshikazu D Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Takei
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Liu L, Jin J, Wang M, Xu X, Jiang H, Chen Z, Li Y, Gao J, Zhang W. Association of Pre-procedural Nutritional Indicators with Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Intervention. Int Heart J 2023; 64:417-426. [PMID: 37258118 DOI: 10.1536/ihj.22-475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Nutritional risk is closely related to the poor prognosis of hospitalized patients. However, the association of pre-procedural nutritional risk with periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) remains unclear.A total of 22,267 patients who underwent elective PCI were enrolled in this retrospective cross-sectional study. Nutritional risk was evaluated by three nutritional risk assessment tools, namely, controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI). PMI after PCI was defined as elevation of cardiac troponin I (cTnI) values > 5 × 99th percentile upper reference limit. Linear regression analysis was performed to explore the association of nutritional risk assessment tools with cTnI fold elevation. Log-binomial regression analysis was conducted to determine the association of nutritional risk assessment tools with PMI.The average age of the enrolled patients was 66.4 years old, and 2,647 of them (11.9%) suffered PMI after PCI. Multivariable linear regression analysis determined a linear association between nutritional risk assessment tools and cTnI fold elevation (CONUT: β = 0.220, 95% CI [0.088-0.352], P = 0.001; PNI: β = -0.105, 95% CI [-0.146 to -0.065], P < 0.001; GNRI: β = -0.090, 95% CI [-0.122 to -0.057], P < 0.001). Log-binomial regression analysis showed that nutritional risk assessment tools were strongly associated with PMI after PCI (CONUT [4-12 versus 0-1]: RR = 1.168, 95% CI [1.054-1.295], P = 0.003; PNI [< 44 versus ≥ 52]: RR = 1.168, 95% CI [1.038-1.315], P = 0.010; GNRI [< 98 versus ≥ 108]: RR = 1.128, 95% CI [1.006-1.264], P = 0.039).Pre-procedural nutritional status, assessed by CONUT, PNI, and GNRI, was significantly and strongly associated with PMI in patients undergoing elective PCI.
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Affiliation(s)
- Lu Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Jinhua Jin
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Manjun Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Xiaoyun Xu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Hangpan Jiang
- Department of Cardiology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University
| | - Zhezhe Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Ya Li
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Jing Gao
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| | - Wenbin Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
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Yabe H, Okada K, Kono K, Imoto Y, Onoyama A, Ito S, Moriyama Y, Kasuga H, Ito Y. Exercise intolerance and malnutrition associated with all-cause mortality in elderly patients undergoing peritoneal dialysis: a single-center prospective cohort study. Int Urol Nephrol 2022. [PMID: 36562903 DOI: 10.1007/s11255-022-03446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Low physical function and malnutrition in elderly patients undergoing peritoneal dialysis (PD) are important issues that may be associated with prognosis. We aimed to determine the association between physical function and nutritional status and survival in elderly patients undergoing PD. METHODS This single-center, prospective cohort study included 45 stable, ambulatory patients undergoing PD. Physical function was measured using the 6-min walk distance (6MWD) test, 10-m walk speed, handgrip strength, lower extremity muscle strength, and short physical performance battery. Nutritional status was assessed using albumin levels and the Geriatric Nutritional Risk Index (GNRI). Patients were divided into two groups according to adverse events. Receiver operating characteristic curve analysis was used to predict mortality. The relationships between all-cause mortality and physical function and nutritional status were studied using Kaplan-Meier analysis and the log-rank test. RESULTS The mean patient age was 75.3 ± 6.5 years. The median follow-up time was 32 (interquartile range 18-51) months, during which 11 deaths occurred. Death during follow-up was significantly associated with lower 6MWD (237.4 ± 120.2 vs. 355.2 ± 105.9 m), lower GNRI (77.3 ± 16.3 vs. 89.3 ± 8.1), and lower albumin levels (2.8 ± 0.6 vs. 3.3 ± 0.4 mg/dL) at baseline (p < 0.05). The cut-off values were 338 m, 83.3, and 2.95 g/dL for the 6MWD, GNRI, and albumin levels, respectively. The 6MWD test, GNRI, and albumin levels were significantly associated with all-cause mortality (p < 0.05). Additionally, the group with combined exercise intolerance and malnutrition had a lower survival rate (p < 0.05). CONCLUSION Lower 6MWD and malnutrition are predictors of mortality in elderly patients undergoing PD.
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Kamimoto T, Shindo K, Shimomura T, Akimoto T, Yamada T, Mori N, Nakao K, Tsujikawa M, Honaga K, Kutsuna T, Hiramatsu K, Kondo K, Liu M. Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106754. [PMID: 36115107 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/18/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.
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Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hikarigaoka Hospital, Shirankai Medical Corporation Takaoka, Toyama, Japan.
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan.
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yamada
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, Tokyo, Japan.
| | - Keiko Nakao
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Oriental Medicine Research Center, Kitasato University, Tokyo, Japan.
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Takeshi Kutsuna
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kazuhisa Hiramatsu
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Higher malnutrition risk in older inpatients who are referred to the department of rehabilitation is related to increase of intramuscular adipose tissue: A prospective study. Clin Nutr 2022; 41:2087-2093. [PMID: 36067581 DOI: 10.1016/j.clnu.2022.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS A recent cross-sectional study reported that a higher intramuscular adipose tissue of the quadriceps is related to higher malnutrition risk in older inpatients. However, a longitudinal relationship between them in older inpatients remains unclear. This study aimed to examine the relationship between the malnutrition risk at hospital admission and change in quadriceps intramuscular adipose tissue induced during the hospital stay in older inpatients. METHODS The inclusion criteria in this longitudinal study were older patients (aged ≥65 years) who were referred to the department of rehabilitation. Patients who died during a hospital stay, who underwent thigh amputation, and who had a hospital stay of <3 days or a lack of data were excluded from the study. Malnutrition risk at post-acute hospital admission was assessed using Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at hospital admission and discharge using echo intensity and muscle thickness on ultrasound images. The changes in quadriceps echo intensity and thickness were calculated by subtracting these baseline values from these values at discharge. Multiple regression analysis was performed to examine whether GNRI at admission is independently and significantly related to the quadriceps echo intensity and thickness at discharge and changes in quadriceps echo intensity and thickness. The independent variables were GNRI, age, sex, days from onset disease, disease, quadriceps echo intensity or thickness at admission, and change in quadriceps thickness. RESULTS This study included 200 inpatients (median [interquartile range] age: 83.0 [77.0-88.0], 57.0% female). GNRI at admission was significantly and independently related to quadriceps echo intensity at discharge (β = -0.136, p = 0.008) and change in quadriceps echo intensity (β = -0.177, p = 0.008). In contrast, GNRI was not significantly and independently related to quadriceps thickness at discharge (β = 0.087, p = 0.158) and change in quadriceps thickness (β = 0.133, p = 0.158). CONCLUSIONS Our results suggest that a higher malnutrition risk at post-acute hospital admission in older inpatients is related to an increase of intramuscular adipose tissue of the quadriceps during the hospital stay. Malnutrition risk at hospital admission in older inpatients is considered to be a predictor for an increase of intramuscular adipose tissue of the quadriceps during a hospital stay.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Horinouchi S, Harada M, Ikeda S, Horinouchi R, Kubo M, Tashiro Y, Ijuin A, Mukai M, Nishio Y. Relationship between diabetic complications and the nutritional index in untreated diabetes. Diabetol Int 2022; 14:58-64. [PMID: 36636155 PMCID: PMC9829937 DOI: 10.1007/s13340-022-00595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 01/16/2023]
Abstract
This study aimed to determine the association between diabetic complications and the nutritional index at the first hospital visit in untreated patients with diabetes. Two hundred and four patients with untreated type 2 diabetes were enrolled in the present study. Nutrition-related risks were assessed using the Geriatric Nutritional Risk Index (GNRI). The patients were divided into the following three subgroups: major/moderate risk, low risk, and no risk. Intergroup comparisons of clinical characteristics were carried out. The risk of complications related to diabetes was associated with the GNRI. The major/moderate-risk group (GNRI < 92) had a high risk for diabetic retinopathy, diabetic nephropathy, and diabetic foot, while the low-risk group (GNRI of 92 to ≤ 98) had a high risk for diabetic nephropathy only. The odds ratio of diabetic retinopathy for a major/moderate risk was 17.6. The odds ratio of diabetic nephropathy for a major/moderate risk was 16.7. Nutritional assessment at the first hospital visit using the GNRI could be a simple and useful tool for predicting the risk of diabetic complications in untreated patients with diabetes.
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Affiliation(s)
- Shuji Horinouchi
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Mihoko Harada
- grid.410788.20000 0004 1774 4188Department of Outpatient Nursing, Kagoshima City Hospital, Kagoshima, Japan
| | - Sakiko Ikeda
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Remi Horinouchi
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Misako Kubo
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuma Tashiro
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Ayako Ijuin
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Miki Mukai
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Yoshihiko Nishio
- grid.258333.c0000 0001 1167 1801Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Nakamura Y, Imada A, Fukugaki A, Kanto S, Yamaura T, Kinjo Y, Kuroda N. Association of nutritional risk and systemic inflammation with survival in patients with colorectal cancer who underwent curative surgery. Clin Nutr ESPEN 2022; 49:417-424. [PMID: 35623847 DOI: 10.1016/j.clnesp.2022.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Malnutrition and inflammation adversely affect the prognosis of patients with cancer. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-C reactive protein ratio (LCR), and C-reactive protein-to-albumin ratio (CAR), predict survival in colorectal cancer (CRC) patients. The present study aimed to examine the association of these two factors with CRC survival. METHODS Subjects were 433 consecutive CRC patients who underwent curative surgery between 2013 and 2018. Patients were stratified by nutritional status, and relationships between overall survival (OS) and systemic inflammation were evaluated. The prognostic impact of combinations of the GNRI and inflammatory markers was assessed. Multivariable analyses were also performed. RESULTS All assessed biomarkers predicted OS in univariable analysis (GNRI:P < 0.001, NLR:P = 0.048, LMR:P = 0.001, LCR:P = 0.010, CAR: P = 0.039). Stratified analysis showed that each inflammatory marker had a prognostic impact on OS in the low GNRI group (NLR:P = 0.028, LMR:P = 0.003, LCR:P = 0.05, CAR:P = 0.009). In contrast, inflammatory markers had no prognostic impact on OS in the high GNRI group. The combination of malnutrition and systemic inflammation had a high prognostic value (all P < 0.016). The multivariable analysis revealed that a low GNRI (hazard ratio: 2.58-2.89) was independently associated with reduced survival, whereas none of the inflammatory markers independently predicted poor prognosis. CONCLUSIONS The GNRI is a useful prognostic biomarker for CRC patients, whereas systemic inflammatory markers can only serve as prognostic factors when patient nutritional status is taken into account. The combination of malnutrition and systemic inflammation may enhance the accuracy of prognostic prediction.
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Affiliation(s)
- Yuya Nakamura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan.
| | - Ayako Imada
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Atsushi Fukugaki
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Satoshi Kanto
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Tadayoshi Yamaura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Yousuke Kinjo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Nobukazu Kuroda
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, 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: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Tolunay H, Yasar S, Asil S, Yildirim E, Yasar AS, Celik M, Yuksel UC, Barcin C. Prognostic Value of Nutritional Indexes in Evaluating the 1-Year Results after Implantation of the Carillon Mitral Contour System. Acta Cardiol Sin 2022; 38:362-372. [PMID: 35673339 PMCID: PMC9121758 DOI: 10.6515/acs.202205_38(3).20211222a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 12/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prognostic importance of nutritional indexes has been shown in some diseases. We aimed to examine the prognostic value of these indexes in patients implanted with the Carillon Mitral Contour System (CMCS). METHODS Fifty-four patients who underwent successful CMCS implantation were evaluated. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) scores were calculated. The relationships between these indexes and 1-year clinical outcomes including all-cause mortality and re-hospitalization due to heart failure were investigated. RESULTS In Kaplan-Meier analysis, 1-year all-cause mortality rates were significantly higher in the patients with low PNI and GNRI and high CONUT scores (52.0% vs. 0%, p < 0.001; 54.2% vs. 0%, p < 0.001; 52.4%, 6.1%, p < 0.001; respectively). For the composite endpoint, a significant difference was observed between those below and above the cut-off values (70.0% vs. 16.7%, p < 0.001; 75.0% vs. 23.3%, p < 0.001; 66.7% vs. 20.8%, p < 0.001, respectively). In multivariate Cox regression analysis, GNRI was determined to be an independent predictor of 1-year all-cause mortality [hazard ratio: 0.707; 95% confidence interval: 0.510-0.979; p = 0.037]. CONCLUSIONS Nutritional indexes have prognostic value in predicting 1-year all-cause mortality in severe functional mitral regurgitation patients undergoing CMCS implantation. In particular, GNRI can guide the selection of patients who will benefit from CMCS.
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Affiliation(s)
- Hatice Tolunay
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ayse Saatci Yasar
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Cem Barcin
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
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Dai H, Xu J. Preoperative geriatric nutritional risk index is an independent prognostic factor for postoperative survival after gallbladder cancer radical surgery. BMC Surg 2022; 22:133. [PMID: 35392884 PMCID: PMC8991798 DOI: 10.1186/s12893-022-01575-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Currently, the surgical outcomes of gallbladder cancer (GBC) are not always satisfactory. The geriatric nutritional risk index (GNRI) can effectively assess nutritional status. This study intends to investigate whether the preoperative GNRI can predict the prognosis of GBC. Methods 202 consecutive GBC patients who underwent treatment from 2010 to 2017 were selected and analyzed retrospectively. By using the univariate and multivariate Cox regression analyses on overall survival (OS) and recurrence-free survival (RFS), the preoperative GNRI of GBC patients was evaluated. Results Among the 202 patients, the GNRI of the 86 patients (42.6%) was less than 98. The patients with low preoperative GNRI had the median OS of 26 months, which was less than the median OS of 39 months among those patients who had higher preoperative GNRI (P < 0.001). Univariate analysis showed that low GNRI was related to short survival time (HR 3.656, 95% CI 2.308–5.790, P < 0.001). In addition, the results of multivariate analysis revealed that, the patients with low GNRI showed a lower OS (HR 2.207, 95% CI 1.131–4.308, P = 0.020) and RFS (HR 2.964, 95% CI 1.577–5.571, P = 0.001) than those patients with higher GNRI. Conclusion GNRI is an independent indicator of poor prognosis in GBC patients after GBC radical surgery.
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Affiliation(s)
- Huifan Dai
- Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Lucheng District, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jing Xu
- Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Lucheng District, Wenzhou, Zhejiang Province, People's Republic of China.
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Araki T, Yamazaki Y, Goto N, Takahashi Y, Ikuyama Y, Kosaka M. Prognostic value of geriatric nutritional risk index for aspiration pneumonia: a retrospective observational cohort study. Aging Clin Exp Res 2022; 34:563-571. [PMID: 34379292 DOI: 10.1007/s40520-021-01948-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The clinical characteristics and prognostic factors of aspiration pneumonia remain poorly defined. Geriatric nutrition risk index (GNRI) has recently been reported to exhibit a prognostic value for several diseases in older adults. AIMS We investigated the clinical characteristics and prognostic significance of GNRI for aspiration pneumonia in older adult patients. METHODS In this retrospective observational cohort study, conducted in a single-institute acute-phase community hospital, patients with aspiration pneumonia diagnosed at our institute between April 2014 and March 2016 were enrolled. Data on patient characteristics, microbiological findings, and clinical course were collected. The outcome was in-hospital mortality. Receiver operating characteristic curve (ROC) analysis was conducted to compare the predictive value of each parameter. Logistic regression analysis was performed to identify independent prognostic factors. RESULTS Overall, 587 aspiration pneumonia patients aged ≥ 65 years were enrolled. Their mean age was 86 years. Among them, 97 (16.5%) died. In ROC analysis for in-hospital mortality, as compared to albumin, body mass index, and A-DROP score, GNRI had a greater area under the curve value, with a significant difference between GNRI and albumin (p = 0.0058). Male sex (p = 0.028), chronic heart failure (p = 0.023), history of malignancy (p = 0.0025), lower GNRI (p < 0.001), and initial antibiotic change (p < 0.001) were identified as independent adverse prognostic factors in multivariate analysis. DISCUSSION AND CONCLUSIONS Our findings indicate that GNRI is a potential prognostic marker for older adults with aspiration pneumonia and may act as a proxy for disease severity. Our results support the use of GNRI in the clinical management of aspiration pneumonia.
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Miyanaga S, Komukai K, Kubota T, Shirasaki K, Oki Y, Yoshida R, Fukushima K, Maehara T, Yamamoto H, Niijima A, Yoshimura M. Cancer and malnutrition were independently associated with a poor prognosis in patients with heart failure. J Cardiol 2022; 79:15-20. [PMID: 34865821 DOI: 10.1016/j.jjcc.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent advances in treatment have improved the survival of cancer patients. Such survivors may go on to develop heart failure (HF) later in life. HF and cancer are wasting diseases, and malnutrition is associated with a poor prognosis in patients with HF or cancer. METHODS AND RESULTS Patients admitted to our hospital with HF from April 2012 to March 2020 were retrospectively reviewed. They were divided into 2 groups: cancer patients (N = 185) and patients without cancer (N = 930). Patients discharged alive and followed by our outpatient clinic were also examined (N = 857, median follow-up period: 794 days). RESULTS In cancer patients, the geriatric nutritional risk index and prognostic nutritional index were lower and the controlling nutritional status score was higher than in HF patients without cancer; nutrition was disturbed in HF patients with cancer. The in-hospital mortality rates of the two groups were not markedly different; however, cancer patients showed higher long-term mortality in comparison to HF patients without cancer. A multivariate analysis revealed that cancer and malnutrition were independently associated with all-cause death. CONCLUSIONS The long-term mortality of HF patients with cancer was higher than that of HF patients without cancer. Malnutrition was associated with long-term mortality, independently of the presence of cancer. Multidisciplinary treatment is needed when treating HF patients with cancer.
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Kataoka M, Hirano Y, Ishii T, Ishikawa S, Kataoka A, Fujii T, Shimamura S. Prognostic Utility of Geriatric Nutritional Risk Index After Curative Resection of Colorectal Cancer: A Propensity Score-matched Study. Cancer Diagn Progn 2021; 1:479-484. [PMID: 35403165 PMCID: PMC8962875 DOI: 10.21873/cdp.10064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND/AIM The geriatric nutrition risk index (GNRI) is a presumptive prognosticator in a variety of carcinomas. We investigated whether it similarly predicts outcomes of elderly patients with colorectal cancer (CRC). PATIENTS AND METHODS A total of 904 older adults (≥65 years) undergoing radical resections of CRC between April 2011 and December 2015 proved eligible for study. Each was grouped by preoperative status (cut-off point, 98) as low-level or normal GNRI, using propensity score matching to compare rates of complications, disease-free survival (DFS), and overall survival (OS). RESULTS After matching (n=127, each group), those with low-level (vs. normal) GNRI values experienced significantly more complications (p=0.001), and 5-year survival was significantly poorer (DFS: p=0.006; OS: p=0.002). CONCLUSION In elderly patients with resected CRC, preoperative GNRI may have significant prognostic merit.
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Affiliation(s)
- Masahiro Kataoka
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasumitsu Hirano
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshimasa Ishii
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shintaro Ishikawa
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuko Kataoka
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takatsugu Fujii
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Satoshi Shimamura
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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Nouri A, Mansour-Ghanaei R, Esmaeilpour-Bandboni M, Gholami Chaboki B. Geriatric nutritional risk index in prediction of muscular strength of elderly patients undergoing hemodialysis. Int Urol Nephrol 2021; 54:1575-1581. [PMID: 34674148 DOI: 10.1007/s11255-021-03034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Geriatric nutritional risk index (GNRI) is one of the new tools to determine nutritional status in the elderly. This study assessed the association between GNRI and muscular strength through handgrip strength (HGS) in patients undergoing hemodialysis. METHODS This cross-sectional analytical study assessed 110 hemodialysis patients at Guilan, North of Iran, (mean age of 70.3 ± 6.93), 57 men and 53 women through simple random sampling. Demographic characteristics, GNRI, and HGS of patients were determined. Data were analyzed using descriptive and inferential statistics, including independent t test, AVOVA, Pearson correlation, and linear multiple regression tests. RESULTS The mean values of the GNRI and HGS were 93.90 ± 11.06 and 14.82 ± 3.72, respectively. Finally, it was identified that there is a direct and significant association between GNRI and HGS (p = 0.001, r = 0.734). Linear multiple regression showed that GNRI is an independent predictor of HGS (Adj.R2 = 0.67, βGNRI = 8.13). CONCLUSION GNRI can be used as a predictor of muscular strength in hemodialysis patients.
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Affiliation(s)
- Ali Nouri
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Mansour-Ghanaei
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. .,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Kimura Y, Kimura N, Akazawa M. Increased nutrition-related risk as an independent predictor of the incidence of hypoglycemia in the hospitalized older individuals with type 2 diabetes: a single-center cohort study. Diabetol Int 2021; 12:420-429. [PMID: 34567925 DOI: 10.1007/s13340-021-00499-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/04/2021] [Indexed: 12/22/2022]
Abstract
Background and aims There are few reports on the association between malnutrition and hypoglycemia. The geriatric nutritional risk index (GNRI) allows risk classification by morbidity and mortality resulting from conditions often associated with malnutrition in older individuals. However, the association between GNRI and hypoglycemia is unclear. This study examined the associations between nutrition-related risk and hypoglycemia among older individuals with type 2 diabetes (T2D) using diabetes medication. Methods This single-center historical cohort study included hospitalized patients aged ≥ 65 years with T2D on medication. Nutrition-related risk was assessed using the GNRI and classified into four risk groups. Hypoglycemia and serious hypoglycemia were determined by oral or intravenous glucose intake and blood glucose < 3.9 mmol/L (70 mg/dL) as hypoglycemia, among them blood glucose < 3.0 mmol/L (54 mg/dL) as serious hypoglycemia. Data were recorded at least once during hospitalization. Results Patients who met the criteria (n = 1.754) were included in the study. The participants median age was 75.0 years. During the study, 81 patients (4.6%) experienced hypoglycemia and 7 patients (0.4%) experienced serious hypoglycemia. Hypoglycemia was observed in patients in the major risk (16.0%), moderate risk (9.7%), low risk (5.2%), and no risk (1.5%) groups (p for trend < 0.001). After adjusting for other risk factors, the hazard ratios of hypoglycemic among people with major, moderate, and low risk were 5.50, 3.86, and 2.55, respectively. Conclusions Hypoglycemia increased with increasing nutrition-related risk among older individuals with T2D using diabetes medication. The GNRI is a simple and useful assessment tool in the clinical setting.
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Affiliation(s)
- Yoshinobu Kimura
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588 Japan.,Department of Pharmacy, Soka Municipal Hospital, 2-21-2 Soka, Soka, Saitama 340-8560 Japan
| | - Naoya Kimura
- Department of Pharmacy, Soka Municipal Hospital, 2-21-2 Soka, Soka, Saitama 340-8560 Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588 Japan
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Shimada T, Yamagata T, Kanno Y, Ohira T, Harada Y, Koike Y, Tanaka M, Komabayashi D, Shimizu T, Okano H, Suzuki S, Ito K. Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer. Digestion 2021; 102:630-639. [PMID: 32932255 DOI: 10.1159/000510165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS For early gastric cancer (EGC) treated using endoscopic submucosal dissection (ESD) with poor curability defined by the Japanese Guidelines (non-curative EGC, N-EGC), additional gastrectomy has been recommended. However, N-EGC patients without additional gastrectomy often die of other diseases within a relatively short interval after ESD. It has been unclear whether additional gastrectomy is beneficial or not for such patients. The aim of this study was to clarify predictors for short-term survival of N-EGC patients without additional gastrectomy after ESD. METHODS One hundred six N-EGC patients without additional gastrectomy were included in this study. Factors related to short-term survival, defined as death within 3 years after ESD, were evaluated using uni- and multivariate analyses by comparing patients with and without short-term survival (Groups S and C, respectively). RESULTS During the mean follow-up period of 89 months, 39 patients died (14 patients died within 3 years, being Group S). The cause of death was gastric cancer for only 1 patient in the Group C. The 3- and 5-year overall survival rates were 86.8 and 81.8%, respectively, and the 3- and 5-years disease-specific survival rates were 100 and 98.9%, respectively. Univariate analyses showed that short-term survival was statistically associated with elevated morphology, high-risk status for lymph node metastases as defined by the eCura system, severe comorbidity (Charlson Comorbidity Index [CCI] ≥3), low level of activity in daily living (being unable to go out by oneself), habitation (a nursing home), and several poor nutritional prognostic indices (neutrophil to lymphocyte ratio ≥2.5, geriatric nutritional risk index <92, C-reactive protein ≥1.0). In the multivariate analysis, a high CCI (≥3) was the independent predictor for short-term survival after ESD (odds ratio, 8.1; 95% confidence interval, 1.53-43.0; p = 0.014). CONCLUSIONS Severe comorbidity indicated by a high CCI score (≥3) was the independent predictor for short-term survival for EGC patients without additional gastrectomy after non-curative ESD. Since the cause of death for most patients was not gastric cancer, observational follow-ups without additional gastrectomy might be a reasonable option for patients with a poor general status indicated by a CCI ≥3.
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Affiliation(s)
- Tomohiro Shimada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan,
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshiki Koike
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Megumi Tanaka
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Daichi Komabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shohei Suzuki
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Li ZE, Lu SB, Kong C, Sun WZ, Wang P, Zhang ST. A prospective comparative study of the MNA-SF and GNRI nutritional screening tools in predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis. Aging Clin Exp Res 2021; 33:1947-53. [PMID: 33044736 DOI: 10.1007/s40520-020-01725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Malnutrition is a risk factor for postoperative infectious complications of elderly patients undergoing posterior lumbar arthrodesis. At present, there is no gold standard for nutrition screening tools. We analyzed the value of predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis by comparing the MNA-SF and GNRI. Demographic data, anthropometric measurements, serum albumin, surgical data and the occurrence of infectious complications and LOS were collected. Mini Nutritional Assessment short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI) were performed within 24 h before surgery. Multivariable logistic regression analyses were used to identify predictors of infectious complications. The discriminatory performances of GNRI and MNA-SF scores for the occurrence of infectious complications were determined by receiver operating characteristic curves (ROC) analyses and the area under the curve (AUC). The study included 252 patients with a median age of 76.82 ± 6.41 years (range 70-84 years), and 142 patients (56.3%) were female. There were no significant differences in infectious complications (p = 0.236) and LOS (p = 0.580) among different GNRI categories. 27.3% malnourished patients evaluated by the MNA-SF suffered from infectious complications and 10.1% patients at risk of malnourished had infectious complications. Those patients had statistically significant higher prevalence of infectious complications (p = 0.002) and longer LOS (p = 0.023) than well-nourished patients. Multivariable analysis revealed that preoperative malnutrition and at risk of malnourished by the MNA-SF was significantly associated with infections. The area under the curve (AUC) of MNA-SF was 0.754, which was significantly high than AUC of GNRI (0.623) (Delong's test, p = 0.033). This study demonstrated that MNA-SF is a simple and effective tool for predicting the risk of infectious complications in elderly patients undergoing posterior lumbar arthrodesis.
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Kaneko M, Nagata Y, Nakamura T, Mitsui K, Nitta G, Nagase M, Okata S, Watanabe K, Miyazaki R, Nagamine S, Hara N, Lee T, Nozato T, Ashikaga T, Goya M, Hirao K, Sasano T. Geriatric nutritional risk index as a predictor of arrhythmia recurrence after catheter ablation of atrial fibrillation. Nutr Metab Cardiovasc Dis 2021; 31:1798-1808. [PMID: 33985896 DOI: 10.1016/j.numecd.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The nutritional risk of patients who undergo atrial fibrillation (AF) ablation varies. Its impact on the recurrence after ablation is unclear. We sought to evaluate the relationship between the nutritional risk and arrhythmia recurrence in patients who undergo AF ablation. METHODS AND RESULTS We enrolled 538 patients (median 67 years, 69.9% male) who underwent their first AF ablation. Their nutritional risk was evaluated using the pre-procedural geriatric nutritional risk index (GNRI), and the patients were classified into two groups: No-nutritional risk (GNRI ≧ 98) and Nutritional risk (GNRI < 98). The primary endpoint was a recurrence of an arrhythmia, and its relationship to the nutritional risk was evaluated. We used propensity-score matching to adjust for differences between patients with a GNRI-based nutritional risk and those without a nutritional risk. A nutritional risk was found in 10.6% of the patients, whereas the remaining 89.4% had no-nutritional risk. During a mean follow-up of 422 days, 91 patients experienced arrhythmia recurrences. The patients with a nutritional risk had a significantly higher arrhythmia recurrence rate both in the entire study cohort (Log-rank p = 0.001) and propensity-matched cohort (Log-rank p = 0.006). In a Cox proportional hazard analysis, the nutritional risk independently predicted arrhythmia recurrences in the entire study cohort (hazard ratio [HR]: 3.91, 95% confidence interval [CI]: 1.84-8.35, p < 0.001) and propensity-matched cohort (HR: 6.49, 95% CI: 1.42-29.8, p = 0.016). CONCLUSION A pre-procedural malnutrition risk was significantly associated with increased arrhythmia recurrences in patients who underwent AF ablation.
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Affiliation(s)
- Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tomofumi Nakamura
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kentaro Mitsui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital, Kanagawa, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Li H, Cen K, Sun W, Feng B. Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis. Aging Clin Exp Res 2021; 33:1477-86. [PMID: 32766928 DOI: 10.1007/s40520-020-01656-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Geriatric Nutritional Risk Index (GNRI) is a promising tool for predicting nutrition-related complications. This meta-analysis sought to determine the prognostic utility of GNRI in elderly patients with heart failure. METHODS We comprehensively searched the PubMed and Embase databases from their inception to July 2019. Original studies investigating the prognostic value of GNRI in patients with heart failure were included. Outcome of interests were all-cause mortality and major cardiovascular events. The prognostic value of GNRI was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the lowest versus the highest GNRI category or continuous GNRI analysis. RESULTS Eleven articles (10 studies) involving 10,589 elderly heart failure patients were included. Meta-analysis indicated that heart failure patients with the lowest GNRI had an increased risk of all-cause mortality (RR 2.11; 95% CI 1.72-2.58) and major cardiovascular events (RR 2.00; 95% CI 1.24-3.22) after adjustment for confounding. In addition, each unit reduction in GNRI significantly increased 6% risk of all-cause mortality. CONCLUSION Lower GNRI independently predicts all-cause mortality and major cardiovascular events in elderly patients with heart failure. Determination of nutritional status using GNRI may improve risk stratification in elderly patients with heart failure.
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Tobe A, Tanaka A, Tokuda Y, Akita S, Miki Y, Furusawa K, Ishii H, Usui A, Murohara T. Improvement in the nutritional status after transcatheter aortic valve implantation. J Cardiol 2021; 78:250-4. [PMID: 33992501 DOI: 10.1016/j.jjcc.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A poor nutritional status of patients before transcatheter aortic valve implantation (TAVI) has been reported to be associated with poor clinical outcomes. However, changes in the nutritional status following TAVI have not been fully elucidated. METHODS In this single-center retrospective observational study, 129 patients whose nutritional status at baseline and 6 months after TAVI were available were investigated. The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were used to assess the nutritional status of the patients at baseline and at 6 months. We further assessed changes in the nutritional status of patients in the subgroups stratified according to the baseline levels as low and high. RESULTS The PNI and GNRI values at 6 months were significantly better than at baseline [PNI, baseline: 44.5 (41.0-48.0), 6 months: 46.0 (41.9-48.3), p = 0.02; GNRI, baseline: 95.3 (89.0-100.3), 6 months: 97.8 (91.5-101.4), p = 0.006]. Both PNI and GNRI values at 6 months were significantly better in the patients with a low baseline nutritional status, while no significant change was observed in those with high baseline levels [PNI, low; baseline: 36.8 (36.1-39.4), 6 months: 40.8 (39.0-43.4), p = 0.002, high; baseline: 47.0 (43.0-49.5), 6 months: 46.5 (43.5-50.5), p = 0.44 and GNRI, low; baseline: 86.4 (81.7-88.7), 6 months: 88.6 (83.4-95.3), p = 0.001, high; baseline: 99.8 (95.3-102.8), 6 months: 100.7 (96.8-103.4), p = 0.34]. CONCLUSION Nutritional status of patients might improve during the chronic phase after TAVI, especially in those with poor baseline levels.
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Kim HR, Kang MG, Kim K, Koh JS, Park JR, Hwang SJ, Jeong YH, Ahn JH, Park Y, Bae JS, Kwak CH, Hwang JY, Park HW. Comparative analysis of three nutrition scores in predicting mortality after acute myocardial infarction. Nutrition 2021; 90:111243. [PMID: 33940560 DOI: 10.1016/j.nut.2021.111243] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We investigated the utility of nutrition scores in predicting mortality and prognostic importance of nutrition status using three different scoring systems in patients with acute myocardial infarction (AMI). METHODS In total, 1147 patients with AMI were enrolled in this study (72.5 % men; mean age 65.6 years). Patients were divided into three groups according to the geriatric nutritional risk index (GNRI); prognostic nutritional index (PNI); and triglycerides, total cholesterol, and body weight index(TCBI) scores as tertile: low (GNRI ≤ 103.8, n = 382), intermediate (103.8 < GNRI ≤ 112.3, n = 383), and high (GNRI > 112.3, n = 382) GNRI groups; low (PNI ≤ 50.0, n = 382), intermediate (50.0 < PNI ≤ 56.1, n = 383), and high (PNI > 56.1, n = 382) PNI groups; and low (TCBI ≤ 1086.4, n = 382), intermediate (1086.3 < GNRI ≤ 2139.1, n = 383), and high (TCBI > 2139.1, n = 382) TCBI groups. RESULTS In the GNRI, TCBI, and PNI groups, the cumulative incidence of all-cause death and major adverse cardiovascular events (MACEs) was significantly higher in the low score group, followed by the intermediate and high score groups. Moreover, both intermediate and low PNI groups had a similar cumulative incidence of all-cause death and MACE. The GNRI score (AUC 0.753, 95% CI 0.608~0.745, P = 0.009) had significantly higher areas under the curve (AUCs) than the TCBI (AUC 0.659, 95% CI 0.600~0.719, reference) and PNI (AUC 0.676, 95% CI 0.608~0.745, P = 0.669) scores. CONCLUSIONS Patients with low nutrition scores were at a higher risk of MACE and all-cause death than patients with high nutrition scores. Additionally, the GNRI had the greatest incremental value in predicting risks among the three different scoring systems used in this study.
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Affiliation(s)
- Hye-Ree Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Kyehwan Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jeong Rang Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jong Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Seok Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyun-Woong Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
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Tsuneyoshi S, Matsukuma Y, Kawai Y, Hiyamuta H, Yamada S, Kitamura H, Tanaka S, Taniguchi M, Tsuruya K, Nakano T, Kitazono T. Association between geriatric nutritional risk index and stroke risk in hemodialysis patients: 10-Years outcome of the Q-Cohort study. Atherosclerosis 2021; 323:30-36. [PMID: 33773162 DOI: 10.1016/j.atherosclerosis.2021.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUNDS AND AIMS The geriatric nutritional risk index (GNRI), which is calculated using the serum albumin level and body mass index, is a nutritional marker associated with an increased risk of cardiovascular events in patients who are receiving hemodialysis. However, no studies have examined the association between the GNRI level and the incidence of stroke in this population. METHODS Three thousand forty-five patients were registered in the Q-Cohort Study, which is a multicenter, observational cohort of hemodialysis patients. The main outcomes were brain infarction and brain hemorrhage. The main exposure was GNRI levels at baseline. Patients were divided into quartiles on the basis of baseline GNRI levels: Q1, <90.7; Q2, 90.7-95.5; Q3, 95.6-99.8; Q4, >99.8. The risk of brain infarction or hemorrhage was estimated using the multivariable-adjusted Cox proportional hazard risk models and restricted cubic spline analyses. RESULTS During the 10-year follow-up period, 326 patients developed brain infarction and 149 patients developed brain hemorrhage. Cox proportional hazard risk models showed that the risk of brain infarction and hemorrhage in Q1 was significantly higher than that in Q4 group. The hazard ratios [95% confidence intervals] were 1.49 [1.05-2.12] and 1.89 [1.11-3.20], respectively. Restricted cubic spline curves showed that a lower GNRI was incrementally associated with an increased risk for both brain infarction and brain hemorrhage. CONCLUSIONS Our results suggest that a lower GNRI is an independent risk factor for both brain infarction and hemorrhage in patients who are receiving maintenance hemodialysis.
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Affiliation(s)
- Shoji Tsuneyoshi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Kawai
- Department of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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50
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Kanehira D, Koinuma M, Kato T, Abe T, Sagara A, Sato F, Yumoto T. Relationship between Low Pretreatment Geriatric Nutritional Risk Index and Poor Tolerability of Azacitidine in Patients with Myelodysplastic Syndromes. Ann Nutr Metab 2021; 76:405-412. [PMID: 33662960 DOI: 10.1159/000513542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Predicting tolerability and treatment-related risks associated with azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) before the initiation of therapy is required for appropriate treatment. Thus, in this study, the nutritional status of patients with MDS prior to AZA treatment was evaluated using the geriatric nutritional risk index (GNRI). Tolerability and overall survival (OS) after AZA initiation were also investigated. METHODS This was a single-center retrospective observational study. A total of 59 patients with MDS treated with AZA were assessed using GNRI, and a comparison of undernourished (GNRI <92, n = 27) and non-undernourished (GNRI ≥92, n = 32) patients was performed. RESULTS The undernourished group had a significant reduction in the number of patients that successfully completed 4 cycles of AZA treatment compared with the non-undernourished group (undernourished group, 11/27 patients, 40.7% vs. non-undernourished group, 24/32 patients, 75.0%; p = 0.009). Factors associated with the difference included karyotype and GNRI. There was also a significant increase in the rate of infectious complications in the undernourished group compared with the non-undernourished group (undernourished group, 33/60 cycles, 55.0% vs. non-undernourished group, 31/92 cycles, 33.7%; p = 0.012). Lastly, a significant reduction in OS was observed in the undernourished group compared with the non-undernourished group (undernourished group, 11.5 months; 95% CI, 5.2-16.7 vs. non-undernourished group, 21.9 months; 95% CI, 13.8-24.0; p = 0.026). Factors associated with OS included both the revised International Prognostic Scoring System (IPSS-R) and GNRI. CONCLUSIONS These results indicate that predicting treatment completion and adverse events in patients with MDS prior to AZA treatment is important. This study suggests GNRI may be a valuable nutritional assessment tool for determining tolerability and OS of AZA treatment.
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Affiliation(s)
- Dan Kanehira
- Department of Pharmacy, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan.,Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Nakano, Tokyo, Japan
| | - Toshiaki Kato
- Department of Pharmacy, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan
| | - Tomoya Abe
- Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan.,Department of Pharmacy, Saitama Cancer Center, Kitaadachi, Saitama, Japan
| | - Atsunobu Sagara
- Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan
| | - Fumiaki Sato
- Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan
| | - Tetsuro Yumoto
- Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan,
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