老年营养风险指数（GNRI）与急性肾损伤（AKI）危重症患者住院死亡率的关系。

The relationship between Geriatric Nutritional Risk Index (GNRI) and in-hospital mortality in critically ill patients with Acute Kidney Injury (AKI).

机构信息

Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No.1 Dongjiaominxiang Road, Beijing, 100730, China.

出版信息

BMC Anesthesiol. 2024 Sep 6;24(1):313. doi: 10.1186/s12871-024-02689-1.

DOI:10.1186/s12871-024-02689-1

PMID:39242503

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11378587/

Abstract

BACKGROUND

The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain.

OBJECTIVES

The aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI.

METHODS

For this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI < 98), and no risk (GNRI ≥ 98). Multivariate analysis was used to evaluate the relationship between GNRI and outcomes.

RESULTS

Patients with higher nutrition-related risk tended to be older, female, had lower blood pressure, lower body mass index, and more comorbidities. Multivariate analysis showed GNRI scores were associated with in-hospital mortality. (Major risk vs. No risk: OR, 95% CI: 1.90, 1.54-2.33, P < 0.001, P for trend < 0.001). Moreover, increased nutrition-related risk was negatively associated with the length of hospital stay (Coefficient: -0.033; P < 0.001) and the length of ICU stay (Coefficient: -0.108; P < 0.001). The association between GNRI scores and the risks of in-hospital mortality was consistent in all subgroups.

CONCLUSIONS

GNRI serves as a significant nutrition assessment tool that is pivotal to predicting the prognosis of critically ill patients with AKI.

摘要

背景

老年营养风险指数（GNRI）作为重症监护病房（ICU）急性肾损伤（AKI）患者的预后因素的作用仍不确定。

目的

本研究旨在探讨 GNRI 对重症 AKI 患者死亡率的影响。

方法

本回顾性研究纳入了 eICU 协作研究数据库中根据 ICD-9 编码诊断为 AKI 的 12058 例患者。根据 GNRI 值，将与营养相关的风险分为 4 组：高风险（GNRI < 82）、中度风险（82 ≤ GNRI < 92）、低风险（92 ≤ GNRI < 98）和无风险（GNRI ≥ 98）。采用多变量分析评估 GNRI 与结局之间的关系。

结果

与低风险组相比，高营养相关风险组的患者年龄更大、女性更多、血压更低、体重指数更低、合并症更多。多变量分析显示 GNRI 评分与院内死亡率相关。（高风险与无风险：OR，95%CI：1.90，1.54-2.33，P < 0.001，趋势 P < 0.001）。此外，营养相关风险的增加与住院时间（系数：-0.033；P < 0.001）和 ICU 住院时间（系数：-0.108；P < 0.001）的缩短呈负相关。GNRI 评分与院内死亡率风险之间的关联在所有亚组中均一致。