Department of Geriatrics, Affiliated Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, PR China; Department of Geriatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nan jing University, Nanjing 210002, Jiangsu, PR China.
Department of Geriatrics, Affiliated Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, PR China; Department of Geriatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nan jing University, Nanjing 210002, Jiangsu, PR China; Department of Intensive Care Unit, Zhongda Hospital, Affiliated Hospital of Medical School, Southeast University, Nanjing 210002, Jiangsu, PR China.
Geriatr Nurs. 2024 Sep-Oct;59:321-329. doi: 10.1016/j.gerinurse.2024.07.020. Epub 2024 Aug 6.
Malnutrition is prevalent in geriatric patients and associated with poor prognosis. This study aimed to evaluate the incremental prognostic value of different nutritional assessment tools in patients (90 years and older) with multimorbidity in China.
Patients aged ≥90 years with multimorbidity from the Geriatric Research Center in Nanjing Jinling Hospital from January 1, 2008 to December 31, 2018 were analyzed. Patients were followed until December 31,2022. The nutrition status was assessed according to the mini nutritional assessment (MNA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index score (PNI), respectively. The outcome was all-cause death. Kaplan-Meier method was used to draw the survival curve, and univariate and multivariate Cox proportional risk regression analysis was used to explore the influencing factors of all-cause death in the patients.
160 participants aged 90(90,91) years were included. During a median follow-up of 5.41(3.12-7.64) years, 106(66.25 %) patients died. Deceased patients had lower MNA [20.75(16.75,23.00) vs. 26.00(24.00,26.00); p < 0.001], lower GNRI [96.21±8.75 vs. 100.94±6.80; p = 0.001] and lower PNI [46.16(40.77,49.57) vs. 47.75(45.36,51.53); p = 0.010] than did survivors. According to MNA, GNRI, and PNI score, 93(58.1 %), 72(45.0 %) and 41(25.6 %) of participants were at risk of malnutrition. Multivariate analysis revealed that malnutrition was independently associated with increased risk for mortality by MNA score (adjusted hazard ratio [HR] 2.502, 95 % confidence interval [CI] 1.561-4.009, p<0.001), GNRI score (adjusted HR 1.650, 95 % CI, 1.117-2.438, p = 0.012), and PNI score (adjusted HR 2.894, 95 % CI, 1.891-4.431, p<0.001). Furthermore, the inclusion of malnutrition indicators in the survival prediction model significantly improved the predictive power of mortality.
The risk of malnutrition, as assessed by MNA, GNRI and PNI, in long-lived patients with multimorbidity is a strong independent predictor of mortality and adds significant prognostic information to the survival models.
营养不良在老年患者中很常见，与预后不良有关。本研究旨在评估不同营养评估工具在患有多种疾病（≥90 岁）的中国患者中的预后价值。
纳入 2008 年 1 月 1 日至 2018 年 12 月 31 日期间来自南京金陵医院老年医学研究中心的≥90 岁患有多种疾病的患者。对患者进行随访，直至 2022 年 12 月 31 日。根据微型营养评估（MNA）、老年营养风险指数（GNRI）和预后营养指数评分（PNI）评估营养状况。结局为全因死亡。使用 Kaplan-Meier 法绘制生存曲线，采用单因素和多因素 Cox 比例风险回归分析探讨患者全因死亡的影响因素。
纳入 160 名 90（90，91）岁的参与者。在中位随访 5.41（3.12-7.64）年期间，106（66.25%）名患者死亡。死亡患者的 MNA 评分[20.75（16.75，23.00）比 26.00（24.00，26.00）；p<0.001]、GNRI 评分[96.21±8.75 比 100.94±6.80；p=0.001]和 PNI 评分[46.16（40.77，49.57）比 47.75（45.36，51.53）；p=0.010]均较低。根据 MNA、GNRI 和 PNI 评分，93（58.1%）、72（45.0%）和 41（25.6%）名参与者存在营养不良风险。多因素分析显示，MNA 评分（调整后的危险比[HR]2.502，95%置信区间[CI]1.561-4.009，p<0.001）、GNRI 评分（调整后的 HR 1.650，95%CI，1.117-2.438，p=0.012）和 PNI 评分（调整后的 HR 2.894，95%CI，1.891-4.431，p<0.001）与死亡率增加独立相关。此外，营养不良指标纳入生存预测模型后，显著提高了死亡率的预测能力。
在患有多种疾病的长寿患者中，MNA、GNRI 和 PNI 评估的营养不良风险是死亡率的一个强有力的独立预测因子，并为生存模型提供了重要的预后信息。
