Background

Elderly people with acute respiratory failure (ARF) have prolonged length of hospital stay (LOS) and high mortality rates. Malnutrition is negatively correlated with these LOS and mortality. However, no tools have been used to detect the risk of malnutrition and assist in designing nutritional support for these patients. The geriatric nutritional risk index (GNRI) is reported as a novel tool for evaluating the risk of malnutrition. The aim of this study is to explore the relationship of the GNRI score with mortality and LOS in elderly patients with ARF.

Methods

Data of elderly patients diagnosed with ARF were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) database. A total of 1250 patients were divided into two groups based on their GNRI score: the malnutrition risk group (GNRI ≤ 98) and no risk group (GNRI > 98). The primary endpoints of this study were hospital mortality and hospital LOS.

Results

The higher GNRI score was associated with lower hospital mortality and shorter hospital LOS. Odds ratio (OR) for hospital mortality of patients with nutritional risk (GNRI ≤ 98) was 1.264 (95% CI:1.067–1.497) in the adjusted model. Patients with GNRI ≤98 had longer hospital LOS (adjusted OR: 1.142, 95%CI: 1.044–1.250) compared with those with GNRI > 98. Subgroup analysis showed that higher GNRI was only significantly associated with lower hospital mortality in the patients that did not undergo mechanical ventilator (MV) treatment (adjusted OR: 0.985, 95% CI: 0.977–0.992, P < 0.01). Kaplan-Meier curve analysis showed that the 90-day survival was significantly lower in the group with nutrition risk (GNRI≤98) compared with the no risk group (GNRI > 98, p < 0.05).

Conclusion

These findings imply that GNRI is a useful prognostic tool in elderly patients with ARF.

中文翻译：

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老年急性呼吸衰竭患者老年营养风险指数与死亡率和住院时间的关系：一项回顾性队列研究

背景

患有急性呼吸衰竭 (ARF) 的老年人住院时间 (LOS) 延长，死亡率高。营养不良与这些 LOS 和死亡率呈负相关。然而，尚未使用任何工具来检测营养不良的风险并协助为这些患者设计营养支持。据报道，老年营养风险指数 (GNRI) 是一种评估营养不良风险的新工具。本研究的目的是探讨老年 ARF 患者 GNRI 评分与死亡率和 LOS 的关系。

方法

诊断为 ARF 的老年患者的数据是从重症监护医疗信息市场 III (MIMIC-III) 数据库中检索的。共有 1250 名患者根据其 GNRI 评分分为两组：营养不良风险组（GNRI ≤ 98）和无风险组（GNRI > 98）。本研究的主要终点是医院死亡率和医院 LOS。

结果

较高的 GNRI 评分与较低的医院死亡率和较短的医院 LOS 相关。在调整后的模型中，具有营养风险（GNRI ≤ 98）的患者住院死亡率的比值比（OR）为 1.264（95% CI：1.067–1.497）。与 GNRI > 98 的患者相比，GNRI ≤ 98 的患者住院 LOS 更长（调整后的 OR：1.142，95%CI：1.044-1.250）。未接受机械呼吸机 (MV) 治疗（调整后的 OR：0.985，95% CI：0.977–0.992，P  < 0.01）。Kaplan-Meier曲线分析显示，营养风险组（GNRI≤98）的90天生存率显着低于无风险组（GNRI>98，p  <0.05）。

结论

这些发现意味着 GNRI 是老年 ARF 患者的有用预后工具。