Deartment of Thyroid Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China.
Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, P.R. China.
BMC Infect Dis. 2023 Aug 14;23(1):530. doi: 10.1186/s12879-023-08512-5.
Invasive candidiasis is the most common hospital-acquired fungal infection in intensive care units (ICU). The Geriatric Nutritional Risk Index (GNRI) score was developed to evaluate the nutritional status of elderly adults. We aimed to assess the association between the GNRI score and the risk of invasive candidiasis in elderly patients admitted to ICU.
Hospitalization information of elderly patients with invasive candidiasis was collected retrospectively from Medical Information Mart for Intensive Care (MIMIC) IV and MIMIC-III Clinical Database CareVue subset from 2001 to 2019. The main outcome of this study was the diagnosis of invasive candidiasis in patients. We employed a multivariable Cox regression and propensity score matching to balance the influence of confounding factors on the outcome. Furthermore, we conducted sensitivity analyses by categorizing the GNRI into classes based on thresholds of 98, 92, and 81.
A total of 6739 patients were included in the study, among whom 134 individuals (2%) were diagnosed with invasive candidiasis. The GNRI scores of patients with invasive candidiasis upon admission to the ICU were significantly lower, measuring 88.67 [79.26-98.27], compared to the control group with a score of 99.36 [87.98-110.45] (P < 0.001). The results of the multivariable Cox regression analysis demonstrated a strong association between higher GNRI scores and a decreased risk of invasive candidiasis infection (HR: 0.98, 95% CI: 0.97-0.99, P = 0.002). Consistently, similar results were obtained when analyzing the propensity score-matched cohort (HR: 0.99, 95% CI: 0.98-1, P = 0.028). Sensitivity analyses further confirmed a significantly increased risk of invasive candidiasis infection with lower GNRI scores. Specifically, the following associations were observed: GNRI ≤ 98 (HR: 1.83, 95% CI: 1.23-2.72, P = 0.003), GNRI ≤ 92 (HR: 1.68, 95% CI: 1.17-2.4, P = 0.005), 82 ≤ GNRI ≤ 92 (HR: 1.63, 95% CI: 1.01-2.64, P = 0.046), GNRI ≤ 81 (HR: 2.31, 95% CI: 1.44-3.69, P < 0.001).
Lower GNRI score was significantly associated with an increased risk of invasive candidiasis in elderly patients in ICU. Further research is needed to validate whether improving nutrition can prevent invasive candidiasis.
侵袭性念珠菌病是重症监护病房（ICU）最常见的医院获得性真菌感染。老年营养风险指数（GNRI）评分旨在评估老年人的营养状况。我们旨在评估 GNRI 评分与 ICU 老年患者侵袭性念珠菌病风险之间的关联。
从 2001 年至 2019 年，我们从医疗信息集市重症监护（MIMIC）IV 和 MIMIC-III 临床数据库 CareVue 子集回顾性收集患有侵袭性念珠菌病的老年患者的住院信息。本研究的主要结局是患者的侵袭性念珠菌病诊断。我们采用多变量 Cox 回归和倾向评分匹配来平衡混杂因素对结局的影响。此外，我们通过根据 98、92 和 81 的阈值将 GNRI 分类为不同类别来进行敏感性分析。
共纳入 6739 例患者，其中 134 例（2%）被诊断为侵袭性念珠菌病。与对照组的 99.36[87.98-110.45]相比，患有侵袭性念珠菌病的 ICU 患者入院时的 GNRI 评分明显较低，为 88.67[79.26-98.27]（P<0.001）。多变量 Cox 回归分析的结果表明，较高的 GNRI 评分与侵袭性念珠菌病感染风险降低之间存在很强的关联（HR：0.98，95%CI：0.97-0.99，P=0.002）。当分析倾向评分匹配的队列时，也得到了类似的结果（HR：0.99，95%CI：0.98-1，P=0.028）。敏感性分析进一步证实了 GNRI 评分较低与侵袭性念珠菌病感染风险显著增加之间的关系。具体而言，观察到以下关联：GNRI≤98（HR：1.83，95%CI：1.23-2.72，P=0.003），GNRI≤92（HR：1.68，95%CI：1.17-2.4，P=0.005），82≤GNRI≤92（HR：1.63，95%CI：1.01-2.64，P=0.046），GNRI≤81（HR：2.31，95%CI：1.44-3.69，P<0.001）。
较低的 GNRI 评分与 ICU 老年患者侵袭性念珠菌病风险增加显著相关。需要进一步研究以验证改善营养是否可以预防侵袭性念珠菌病。
