Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Department of Internal Medicine, Sakura Medical Center, Toho University, Chiba, Japan.
J Gastroenterol Hepatol. 2021 Jan;36(1):163-170. doi: 10.1111/jgh.15161. Epub 2020 Jul 8.
Worldwide increasing aging societies have many elderlies with intractable diseases including ulcerative colitis (UC). Reportedly, each patients' frailty as well as chronological age is a clinical risk factor of elderly-onset UC (EOUC). Because malnutrition is one of the major manifestations of frailty, we aimed to investigate the effect of malnutrition on the prognosis of EOUC with geriatric nutritional risk index (GNRI), a prognostic tool for several diseases in the elderly to estimate malnutrition, and to evaluate clinical risks among EOUC patients in Japan, the world-leading aging society.
The EOUC patients (≥ 65 years at diagnosis, n = 2778) in the previous nationwide survey were classified by age and GNRI, and odds ratios (ORs) of hospitalization and UC-related surgery were determined to evaluate the effects of malnutrition on the EOUC patients as well as aging.
The risks of hospitalization and surgery were elevated as age advanced. The value of GNRI, negatively correlated with disease activity (r = -0.53), could distinguish severe activity (cutoff ≤ 86.82, sensitivity = 0.79, and specificity = 0.77) and discriminate the EOUC patients suffering from surgery and hospitalization. In a multivariate analysis, GNRI ≤ 86.82 was a higher risk of hospitalization (OR: 4.0, 95% CI, 2.5-6.5) and surgery (OR: 2.7, 95% CI, 0.98-7.4) than cutoff age ≥ 75 years old (OR of hospitalization and surgery were 1.4 [95% CI, 0.99-2.0] and 2.3 [95% CI, 0.8-6.3], respectively).
Malnutrition estimated by GNRI was significantly related with poor clinical courses of the EOUC patients, suggesting that evaluation of nutritional status at the onset might be useful for predicting risks of clinical courses.
全球老龄化社会中，许多老年人患有溃疡性结肠炎（UC）等难治性疾病。据报道，每位患者的虚弱程度和年龄都是老年发病 UC（EOUC）的临床危险因素。由于营养不良是虚弱的主要表现之一，我们旨在通过老年营养风险指数（GNRI）来研究营养不良对 EOUC 预后的影响，该指数是一种用于评估老年人多种疾病中营养不良的预后工具，并评估日本这一全球领先的老龄化社会中 EOUC 患者的临床风险。
将之前全国性调查中（≥65 岁诊断的）EOUC 患者（n=2778）按年龄和 GNRI 分类，确定住院和 UC 相关手术的比值比（ORs），以评估营养不良对 EOUC 患者和衰老的影响。
随着年龄的增长，住院和手术的风险增加。与疾病活动度呈负相关的 GNRI 值（r=-0.53），可以区分严重活动度（截断值≤86.82，灵敏度=0.79，特异性=0.77），并区分接受手术和住院治疗的 EOUC 患者。在多变量分析中，GNRI≤86.82 与住院（OR：4.0，95%CI，2.5-6.5）和手术（OR：2.7，95%CI，0.98-7.4）的风险更高，而截止年龄≥75 岁的 OR 分别为 1.4（95%CI，0.99-2.0）和 2.3（95%CI，0.8-6.3）。
GNRI 估计的营养不良与 EOUC 患者不良临床病程显著相关，提示在发病时评估营养状况可能有助于预测临床病程的风险。
