Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China.
Health Service Department of the Guard Bureau of the Joint Staff Department, 100017, Beijing, China.
BMC Geriatr. 2023 Oct 27;23(1):697. doi: 10.1186/s12877-023-04413-z.
Estimates of survival in the older can be of benefit in various facets, particularly in medical and individual decision-making. We aim to validate the value of a combination of nutrition status evaluation and comorbidity assessment in predicting long-term survival among community-dwelling older.
The Charlson Comorbidity Index (CCI) was applied for comprehensive evaluation of comorbidities. Participants were classified into CCI score ≤ 2 and ≥ 3 subgroups. Nutritional status was assessed by using Mini Nutritional Assessment-Short Form (MNA-SF) and Geriatric Nutritional Risk Index (GNRI) evaluations. Mortality rates and survival curves over a 5-year period were compared among subgroups classified by CCI and/or MNA-SF/GNRI evaluations.
A total of 1033 elderly male participants were enrolled in this study, with an average age of 79.44 ± 8.61 years. 108 deceased participants (10.5%) were identified during a follow-up of 5 years. Cox proportional hazards regression analysis showed that age, CCI, MNA-SF and GNRI were independent predictors of 5-year all-cause death in this cohort. Compared to those with normal nutrition status and CCI ≤ 2, the subgroup at risk of malnutrition and CCI ≥ 3 had a significantly higher 5-year all-cause mortality rate (HR = 4.671; 95% CI:2.613-8.351 for MNA-SF and HR = 7.268; 95% CI:3.401-15.530 for GNRI; P < 0.001 for both). Receiver operating characteristic curve analysis demonstrated that a combination of either MNA-SF or GNRI with CCI had significantly better performance than CCI, MNA-SF or GNRI alone in predicting all-cause death.
The combination of nutritional assessment (MNA-SF or GNRI) with CCI can significantly improve the predictive accuracy of long-term mortality outcomes among community-dwelling older males.
在老年人中，生存率的估计在各个方面都可能是有益的，特别是在医学和个人决策方面。我们旨在验证营养状况评估和合并症评估相结合在预测社区居住的老年人长期生存方面的价值。
采用 Charlson 合并症指数（CCI）对合并症进行综合评估。将参与者分为 CCI 评分≤2 和≥3 亚组。营养状况通过使用迷你营养评估-简短表格（MNA-SF）和老年营养风险指数（GNRI）评估进行评估。比较了 CCI 和/或 MNA-SF/GNRI 评估分组的亚组之间的死亡率和 5 年生存曲线。
共纳入 1033 名老年男性参与者，平均年龄为 79.44±8.61 岁。在 5 年的随访中，共发现 108 例死亡参与者（10.5%）。Cox 比例风险回归分析显示，年龄、CCI、MNA-SF 和 GNRI 是该队列 5 年全因死亡的独立预测因素。与营养状况正常且 CCI≤2 的亚组相比，存在营养不良和 CCI≥3 风险的亚组的 5 年全因死亡率显著更高（MNA-SF 的 HR=4.671；95%CI：2.613-8.351；GNRI 的 HR=7.268；95%CI：3.401-15.530；均 P<0.001）。受试者工作特征曲线分析表明，MNA-SF 或 GNRI 与 CCI 的组合在预测全因死亡方面的表现明显优于 CCI、MNA-SF 或 GNRI 单独使用。
营养评估（MNA-SF 或 GNRI）与 CCI 的结合可显著提高社区居住的老年男性长期死亡率预测的准确性。
