Zhang Xueyang, Wang Yu, Xu Minmin, Zhang Yuanyi, Lyu Quanjun
College of Public Health, Zhenghou University, Zhengzhou, Henan, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Front Nutr. 2024 Aug 9;11:1365462. doi: 10.3389/fnut.2024.1365462. eCollection 2024.
The management of nutritional risk has garnered significant attention in individuals diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) due to the high prevalence of malnutrition and its correlation with unfavorable outcomes. While numerous rating scales exist to assist in assessment for both clinical and research purposes, there is considerable variability in the selection of scales based on the characteristics of the study participants and the study design. The objective of this study was to examine the efficacy of the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) in identifying malnutrition and predicting prognosis in elderly AECOPD patients.
From January 2022 to December 2022, a consecutive inclusion of elderly AECOPD patients admitted to the First Affiliated Hospital of Zhengzhou University was conducted. Diagnosing malnutrition in patients using PNI and GNRI, comparing the results with the diagnostic outcomes based on the Global Leadership Initiative on Malnutrition (GLIM) criteria through Receiver Operating Characteristic curves. Logistic regression analysis was employed to assess the risks associated with length of stay (LOS), hospitalization costs, and Charlson Comorbidity Index (CCI) based on GLIM, GNRI, or PNI.
A total of 839 elderly AECOPD patients were investigated in the study. The GNRI and PNI demonstrated a sensitivity of 89.5 and 74.1%, specificity of 77.2 and 66.4%, and an area under the curve of 0.834 and 0.702, respectively. The identification of high malnutrition-risk cases using the GLIM, GNRI and PNI were associated with a significant increase in the risk of LOS over 7 days [odds ratio (95% CI) for GLIM, GNRI, PNI: 1.376 (1.033-1.833); 1.405 (1.070-1.846); 1.875 (1.425-2.468)] and higher hospitalization expenses [OR (95% CI) for GLIM, GNRI: 1.498 (1.080-2.080); 1.510 (1.097-2.079)], but not with the CCI.
According to our study, it is possible to use GNRI and PNI as alternatives to GLIM in the context of AECOPD, which makes it easier to identify malnutrition. The utilization of GNRI and PNI as alternatives to GLIM in the context of AECOPD enables the identification of malnutrition. The presence of malnourished individuals experiencing AECOPD is correlated with higher probabilities of extended hospital stays and escalated in-hospital expenses.
由于营养不良在慢性阻塞性肺疾病急性加重期（AECOPD）患者中普遍存在且与不良预后相关，因此营养风险的管理在这类患者中受到了广泛关注。虽然有许多评分量表可用于临床和研究评估，但根据研究参与者的特征和研究设计，量表的选择存在很大差异。本研究的目的是探讨老年慢性阻塞性肺疾病急性加重期患者中，老年营养风险指数（GNRI）和预后营养指数（PNI）在识别营养不良和预测预后方面的有效性。
2022年1月至2022年12月，连续纳入郑州大学第一附属医院收治的老年慢性阻塞性肺疾病急性加重期患者。使用PNI和GNRI对患者进行营养不良诊断，并通过受试者工作特征曲线将结果与基于全球营养不良领导倡议（GLIM）标准的诊断结果进行比较。采用逻辑回归分析，基于GLIM、GNRI或PNI评估与住院时间（LOS）、住院费用和Charlson合并症指数（CCI）相关的风险。
本研究共调查了839例老年慢性阻塞性肺疾病急性加重期患者。GNRI和PNI的敏感性分别为89.5%和74.1%，特异性分别为77.2%和66.4%，曲线下面积分别为0.834和0.702。使用GLIM、GNRI和PNI识别高营养不良风险病例与住院7天以上风险显著增加相关[GLIM、GNRI、PNI的比值比（95%置信区间）：1.376（1.033 - 1.833）；1.405（1.070 - 1.846）；1.875（1.425 - 2.468）]以及住院费用更高[GLIM、GNRI的OR（95%置信区间）：1.498（1.080 - 2.080）；1.510（1.097 - 2.079）]，但与CCI无关。
根据我们的研究，在慢性阻塞性肺疾病急性加重期的背景下，可以使用GNRI和PNI作为GLIM的替代方法，这使得营养不良的识别更加容易。在慢性阻塞性肺疾病急性加重期的背景下，使用GNRI和PNI作为GLIM的替代方法能够识别营养不良。慢性阻塞性肺疾病急性加重期的营养不良患者延长住院时间和住院费用增加的可能性更高。
