Zhu Bingcheng, Ou Yunwei, Guo Xufei, Liu Weiming, Wu Liang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2023 Apr 4;14:1131085. doi: 10.3389/fneur.2023.1131085. eCollection 2023.
The geriatric nutritional risk index (GNRI) is a simple index for evaluating the nutrition status of elderly patients. Many investigations have demonstrated that this index is associated with the prognosis of several diseases. This study aims to identify the relationship between the GNRI and recovery in elderly mild traumatic brain injury (mTBI) patients.
A total of 228 mTBI patients older than 65 years were included in this study. mTBI was defined as an injury to the brain with a loss of consciousness of 30 min or less, a duration of posttraumatic amnesia of <24 h, and an admission Glasgow Coma Scale (GCS) score of 13-15. The Glasgow Outcome Scale Extended (GOSE), an outcome scale assessing functional independence, work, social activities, and personal relationships, was applied to assess the recovery of the patients. The clinical outcome was divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7) at 6 months after the injury. Multivariate logistic regression was applied to evaluate the association between the GNRI and recovery of elderly mTBI patients, with adjustment for age, sex, hypertension, diabetes, and other important factors.
The receiver operating curve (ROC) analysis demonstrated that the cutoff value of GNRI was 97.85, and the area under the curve (AUC) was 0.860. Compared to the patients with a high GNRI, the patients with a low GNRI were older, had a higher prevalence of anemia, acute subdural hematoma, and subarachnoid hemorrhage, had a higher age-adjusted Charlson Comorbidity Index value, and had lower levels of albumin, lymphocytes, and hemoglobin. Multivariable analysis showed that high GNRI was associated with a lower risk of 6-month incomplete recovery (OR, 0.770, 95% CI: 0.709-0.837, < 0.001).
The GNRI has utility as part of the objective risk assessment of incomplete 6-month functional recovery in elderly patients with mTBI.
老年营养风险指数（GNRI）是评估老年患者营养状况的一个简单指标。许多研究表明，该指数与多种疾病的预后相关。本研究旨在确定GNRI与老年轻度创伤性脑损伤（mTBI）患者恢复情况之间的关系。
本研究共纳入228例65岁以上的mTBI患者。mTBI定义为脑损伤，意识丧失30分钟或更短，创伤后遗忘持续时间<24小时，入院时格拉斯哥昏迷量表（GCS）评分为13 - 15分。采用格拉斯哥扩展预后量表（GOSE）评估患者的恢复情况，该量表用于评估功能独立性、工作、社交活动和人际关系。伤后6个月时，将临床结局分为完全恢复（GOSE = 8）和不完全恢复（GOSE≤7）。采用多因素逻辑回归评估GNRI与老年mTBI患者恢复之间的关联，并对年龄、性别、高血压、糖尿病和其他重要因素进行校正。
受试者工作特征曲线（ROC）分析显示，GNRI的截断值为97.85，曲线下面积（AUC）为0.860。与GNRI高的患者相比，GNRI低的患者年龄更大，贫血、急性硬膜下血肿和蛛网膜下腔出血的患病率更高，年龄校正的Charlson合并症指数值更高，白蛋白、淋巴细胞和血红蛋白水平更低。多变量分析显示，高GNRI与6个月时不完全恢复风险较低相关（OR，0.770，95%CI：0.709 - 0.837，<0.001）。
GNRI可作为老年mTBI患者6个月功能不完全恢复客观风险评估的一部分。
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