Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Respiratory Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
BMC Geriatr. 2020 Mar 17;20(1):107. doi: 10.1186/s12877-020-1501-8.
Malnutrition has been shown to be associated with poor prognosis in older surgical patients. Several tools are available for detecting malnutrition. But little is known about their ability to assess risks of postoperative adverse outcomes. The study aimed to compare the ability of the Geriatric Nutritional Risk Index (GNRI) and the Mini-Nutritional Assessment Short Form (MNA-SF) in predicting postoperative delirium (POD) and length of stay (LOS) among older non-cardiac surgical patients.
Prospective study of 288 older non-cardiac surgical patients from the West China Hospital of Sichuan University. Preoperative nutritional status was assessed using the GNRI and MNA-SF, and patients were followed for the occurrence of POD and LOS. Multivariable logistic regression and linear regression analyses were used to identify predictors of these outcomes. The relative performance of the GNRI and MNA-SF as predictors of these outcomes were determined by Receiver Operating Characteristic curves (ROC) analyses and the area under the curve (AUC).
Multivariable analysis revealed that preoperative malnutrition by the MNA-SF was significantly associated with POD. Linear regression analysis showed that preoperative low/high nutritional risk of the GNRI and malnutrition by the MNA-SF were independent predictors of prolonged LOS. Moreover, the area under the curve (AUC) of MNA-SF scores for POD was better than GNRI scores (AUC = 0.718, 95%CI: 0.64-0.80, P < 0.001 vs AUC = 0.606, 95%CI: 0.52-0.69, P = 0.019; Delong's test, P = 0.006), but the AUC of GNRI scores and MNA-SF scores have no significant difference when predicting prolonged LOS (AUC = 0.611, 95%CI: 0.54-0.69, P = 0.006 vs AUC = 0.533, 95%CI: 0.45-0.62, P = 0.421; Delong's test, P = 0.079).
The MNA-SF was more effective than the GNRI at predicting the development of POD, but the two nutrition screening methods have similar performance in predicting prolonged LOS among older non-cardiac surgical patients.
营养不良与老年外科患者的预后不良有关。有多种工具可用于检测营养不良。但是，关于它们评估术后不良结局风险的能力知之甚少。本研究旨在比较老年营养风险指数（GNRI）和简易营养评估量表短表（MNA-SF）预测老年非心脏外科患者术后谵妄（POD）和住院时间（LOS）的能力。
前瞻性研究了来自四川大学华西医院的 288 名老年非心脏外科患者。使用 GNRI 和 MNA-SF 评估术前营养状况，并对患者进行 POD 和 LOS 的发生情况进行随访。多变量逻辑回归和线性回归分析用于确定这些结果的预测因素。通过接收者操作特征曲线（ROC）分析和曲线下面积（AUC）确定 GNRI 和 MNA-SF 作为这些结果预测因子的相对性能。
多变量分析显示，MNA-SF 术前营养不良与 POD 显著相关。线性回归分析表明，GNRI 的术前低/高营养风险和 MNA-SF 的营养不良是 LOS 延长的独立预测因子。此外，MNA-SF 评分对 POD 的 AUC 优于 GNRI 评分（AUC=0.718，95%CI：0.64-0.80，P<0.001 与 AUC=0.606，95%CI：0.52-0.69，P=0.019；Delong 检验，P=0.006），但 GNRI 评分和 MNA-SF 评分预测 LOS 延长时 AUC 无显著差异（AUC=0.611，95%CI：0.54-0.69，P=0.006 与 AUC=0.533，95%CI：0.45-0.62，P=0.421；Delong 检验，P=0.079）。
MNA-SF 预测 POD 发生的效果优于 GNRI，但这两种营养筛查方法在预测老年非心脏外科患者 LOS 延长方面的表现相似。
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