Hung Kuo-Chuan, Kao Chia-Li, Hsu Chih-Wei, Yu Chia-Hung, Lin Chien-Ming, Chen Hsiao-Tien, Chang Ying-Jen, Liao Shu-Wei, Chen I-Wen
Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Front Nutr. 2024 Mar 21;11:1346870. doi: 10.3389/fnut.2024.1346870. eCollection 2024.
This meta-analysis aimed to synthesize current evidence on the association between the Geriatric Nutritional Risk Index (GNRI) and long-term outcomes in patients undergoing hemodialysis.
Electronic databases were systematically searched for relevant studies that investigated the association between GNRI and long-term outcomes in hemodialysis patients until November 2023. The primary outcome was the association between the GNRI (i.e., low versus high) and overall mortality risk, while the secondary outcome was the relationship between the GNRI and cardiovascular mortality risk.
Thirty cohort studies involving 55,864 patients were included. A low GNRI was found to be significantly associated with increased overall mortality (hazard ratio [HR]: 2.42, 95% confidence interval [CIs]: 2.10-2.79, < 0.00001, = 65%). Each unit increase in GNRI corresponded to a 5% reduction in mortality risk (HR: 0.95, 95% CI: 0.93-0.96, < 0.00001, = 79%). The association remained consistent across Asian (HR = 2.45, 95% CI: 2.08-2.88, < 0.00001, = 70%) and non-Asian subgroups (HR = 2.3, 95% CI: 1.72-3.06, < 0.00001, = 23%). Meta-regression analysis of patient age (coefficient: -0.002; = 0.896), male proportion (coefficient: 0.002; = 0.875), percentage of diabetes mellitus (coefficient: -0.003; = 0.605), and follow-up duration (coefficient: -0.003; = 0.431) revealed that these moderator variables did not significantly influence the association between GNRI and overall mortality risk. Cardiovascular mortality risk also increased with low GNRI (HR, 1.93; 95%CI: 1.51-2.45, < 0.00001; = 2%). Similarly, an inverse association was observed between the GNRI values and cardiovascular mortality risk (HR, 0.94; 95% CI: 0.91-0.97; < 0.0001; = 65%) (per unit increase).
The GNRI is a simple nutritional screening tool that can be used to effectively stratify patients undergoing hemodialysis globally. Further studies are warranted to determine whether nutrition optimization based on the GNRI improves long-term outcomes.
https://www.crd.york.ac.uk/prospero/, CRD42023483729.
本荟萃分析旨在综合目前关于老年营养风险指数（GNRI）与血液透析患者长期预后之间关联的证据。
系统检索电子数据库，查找截至2023年11月调查GNRI与血液透析患者长期预后之间关联的相关研究。主要结局是GNRI（即低与高）与总体死亡风险之间的关联，次要结局是GNRI与心血管死亡风险之间的关系。
纳入了30项队列研究，涉及55864名患者。发现低GNRI与总体死亡率增加显著相关（风险比[HR]：2.42，95%置信区间[CIs]：2.10 - 2.79，P < 0.00001，I² = 65%）。GNRI每增加一个单位，死亡风险降低5%（HR：0.95，95%CI：0.93 - 0.96，P < 0.00001，I² = 79%）。在亚洲亚组（HR = 2.45，95%CI：2.08 - 2.88，P < 0.00001，I² = 70%）和非亚洲亚组（HR = 2.3，95%CI：1.72 - 3.06，P < 0.00001，I² = 23%）中，这种关联均保持一致。对患者年龄（系数： - 0.002；P = 0.896）·男性比例（系数：0.002；P = 0.875）·糖尿病百分比（系数： - 0.003；P = 0.605）和随访时间（系数： - 0.003；P = 0.431）进行的Meta回归分析表明，这些调节变量对GNRI与总体死亡风险之间的关联没有显著影响。低GNRI时心血管死亡风险也增加（HR，1.93；95%CI：1.51 - 2.45，P < 0.00001；I² = 2%）。同样，观察到GNRI值与心血管死亡风险之间呈负相关（HR，0.94；95%CI：0.91 - 0.97；P < 0.0001；I² = 65%）（每单位增加）。
GNRI是一种简单的营养筛查工具，可用于在全球范围内有效对血液透析患者进行分层。有必要进一步研究以确定基于GNRI的营养优化是否能改善长期预后。
