Xiong Jiachuan, Wang Min, Zhang Ying, Nie Ling, He Ting, Wang Yiqin, Huang Yunjian, Feng Bing, Zhang Jingbo, Zhao Jinghong
Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Department of Otorhinolaryngology and Head-Neck Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Kidney Blood Press Res. 2018;43(6):1878-1889. doi: 10.1159/000495999. Epub 2018 Dec 14.
BACKGROUND/AIMS: Geriatric nutritional risk index (GNRI) was developed as a "nutrition-related" risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients.
We electronically searched original articles published in peer-reviewed journals from their inception to September 2018 in The PubMed, Embase, and the Cochrane Library databases. The primary outcome was all-cause and cardiovascular mortality. We pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) using Review Manager 5.3 software.
A total of 10,739 patients from 19 cohort studies published from 2010 to 2018 were included. A significant negative association was found between the GNRI and all-cause mortality in patients with chronic hemodialysis (OR, 0.90; 95% CI, 0.84-0.97, p=0.004) (per unit increase) and (OR, 2.15; 95% CI, 1.88-2.46, p＜0.00001) (low vs. high GNRI). Moreover, there was also a significant negative association between the GNRI (per unit increase) and cardiovascular events (OR, 0.98; 95% CI, 0.97-1.00, p=0.01), as well as cardiovascular mortality (OR, 0.89; 95% CI, 0.80-0.99, p=0.03).
Our findings supported the hypothesis that the low GNRI is associated with an increased risk of all-cause and cardiovascular mortality in chronic hemodialysis patients. Based on our literature review, GNRI has been found to be an effective tool for identifying patients with nutrition-related risk of all-cause and cardiovascular disease.
背景/目的：老年营养风险指数（GNRI）作为一种“营养相关”风险指数被提出，在不同人群中均有报道称其与全因死亡风险以及心血管疾病的发病率和死亡率相关。因此，GNRI可用于根据与蛋白质 - 能量消耗（PEW）相关疾病的并发症风险对患者进行分类。然而，并非所有报告都指出了GNRI的预后能力。本研究的目的是评估GNRI与慢性血液透析患者死亡率之间的关联。
我们在PubMed、Embase和Cochrane图书馆数据库中对从创刊至2018年9月发表在同行评审期刊上的原始文章进行了电子检索。主要结局是全因死亡和心血管死亡。我们使用Review Manager 5.3软件汇总未调整和调整后的比值比（OR）以及95%置信区间（95%CI）。
共纳入了2010年至2018年发表的19项队列研究中的10739例患者。在慢性血液透析患者中，发现GNRI与全因死亡率之间存在显著的负相关（OR，0.90；95%CI，0.84 - 0.97，p = 0.004）（每单位增加）以及（OR，2.15；95%CI，1.88 - 2.46，p＜0.00001）（低GNRI与高GNRI相比）。此外，GNRI（每单位增加）与心血管事件（OR，0.98；95%CI，0.97 - 1.00，p = 0.01）以及心血管死亡率（OR，0.89；95%CI，0.80 - 0.99，p = 0.03）之间也存在显著的负相关。
我们的研究结果支持了以下假设，即低GNRI与慢性血液透析患者全因死亡和心血管死亡风险增加相关。基于我们的文献综述，发现GNRI是识别全因和心血管疾病营养相关风险患者的有效工具。
