老年营养风险指数作为老年创伤患者并发症的预测指标。
The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients.
机构信息
From the Division of Acute Care Surgery, Department of Surgery (H.R.K., M.A., D.E.M., E.C.O., S.D.A., C.E.W., J.A.H., L.S.K., T.J.P.), and Center for Surgical Trials and Evidence-based Practice (H.R.K., M.A., D.E.M., S.D.A., J.A.H., L.S.K., T.J.P.), McGovern Medical School at UTHealth; Center for Translational Injury Research (H.R.K., D.E.M., S.D.A., C.E.W., J.A.H., L.S.K., T.J.P.), Houston, Texas; and Department of Surgery (P.B.M., R.S.M.), Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
J Trauma Acute Care Surg. 2022 Aug 1;93(2):195-199. doi: 10.1097/TA.0000000000003588. Epub 2022 Mar 14.
BACKGROUND
Malnutrition is associated with increased morbidity and mortality after trauma. The Geriatric Nutritional Risk Index (GNRI) is a validated scoring system used to predict the risk of complications related to malnutrition in nontrauma patients. We hypothesized that GNRI is predictive of worse outcomes in geriatric trauma patients.
METHODS
This was a single-center retrospective study of trauma patients 65 years or older admitted in 2019. Geriatric Nutritional Risk Index was calculated based on admission albumin level and ratio of actual body weight to ideal body weight. Groups were defined as major risk (GNRI <82), moderate risk (GNRI 82-91), low risk (GNRI 92-98), and no risk (GNRI >98). The primary outcome was mortality. Secondary outcomes included ventilator days, intensive care unit length of stay (LOS), hospital LOS, discharge home, sepsis, pneumonia, and acute respiratory distress syndrome. Bivariate and multivariable logistic regression analyses were performed to determine the association between GNRI risk category and outcomes.
RESULTS
A total of 513 patients were identified for analysis. Median age was 78 years (71-86 years); 24 patients (4.7%) were identified as major risk, 66 (12.9%) as moderate risk, 72 (14%) as low risk, and 351 (68.4%) as no risk. Injury Severity Scores and Charlson Comorbidity Indexes were similar between all groups. Patients in the no risk group had decreased rates of death, and after adjusting for Injury Severity Score, age, and Charlson Comorbidity Index, the no risk group had decreased odds of death (odds ratio, 0.13; 95% confidence interval, 0.04-0.41) compared with the major risk group. The no risk group also had fewer infectious complications including sepsis and pneumonia, and shorter hospital LOS and were more likely to be discharged home.
CONCLUSIONS
Major GNRI risk is associated with increased mortality and infectious complications in geriatric trauma patients. Further studies should target interventional strategies for those at highest risk based on GNRI.
LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.
背景
营养不良与创伤后发病率和死亡率的增加有关。老年营养风险指数（GNRI）是一种经过验证的评分系统，用于预测非创伤患者与营养不良相关并发症的风险。我们假设 GNRI 可预测老年创伤患者的预后更差。
方法
这是一项单中心回顾性研究，纳入了 2019 年收治的 65 岁及以上的创伤患者。根据入院时的白蛋白水平和实际体重与理想体重的比值计算老年营养风险指数。将患者分为高风险（GNRI＜82）、中风险（GNRI 82-91）、低风险（GNRI 92-98）和无风险（GNRI＞98）。主要结局是死亡率。次要结局包括呼吸机使用天数、重症监护病房住院时间（LOS）、医院 LOS、出院回家、脓毒症、肺炎和急性呼吸窘迫综合征。采用双变量和多变量逻辑回归分析确定 GNRI 风险类别与结局之间的关系。
结果
共纳入 513 例患者进行分析。中位年龄为 78 岁（71-86 岁）；24 例（4.7%）为高风险，66 例（12.9%）为中风险，72 例（14%）为低风险，351 例（68.4%）为无风险。所有组的损伤严重程度评分和 Charlson 合并症指数相似。无风险组患者死亡率降低，在校正损伤严重程度评分、年龄和 Charlson 合并症指数后，与高风险组相比，无风险组死亡的可能性降低（比值比，0.13；95%置信区间，0.04-0.41）。无风险组的感染性并发症（包括脓毒症和肺炎）较少，住院时间较短，更有可能出院回家。
结论
GNRI 高风险与老年创伤患者的死亡率和感染性并发症增加相关。应进一步研究基于 GNRI 的针对高危人群的干预策略。
证据水平
预后和流行病学；III 级。
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