Natalia Pavone, MD PhD, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8 00168 Rome (Italy), email:
J Frailty Aging. 2024;13(4):501-506. doi: 10.14283/jfa.2024.54.
Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.
To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.
Retrospective, single-center.
Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.
Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.
Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.
A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.
营养不良与术后不良结局有多种关联。据报道，10-25%的心脏手术患者存在营养不良。
评估营养状况（通过老年营养风险指数-GNRI 评估）对老年心脏瓣膜手术患者结局的影响。
回顾性、单中心研究。
意大利罗马，“A. Gemelli”大学附属医院心脏外科病房。
448 名年龄大于 75 岁、接受择期心脏瓣膜手术的患者。根据营养相关并发症的风险，患者被分为低危（GNRI≥92；346 名患者）和中高危（GNRI<92；102 名患者）组。
从机构心脏瓣膜数据库中提取人口统计学、临床和生物学变量。GNRI 计算如下：[1.489×血清白蛋白（g/dL）]+[41.7×实际体重（kg）/理想体重（kg）]。比较 GNRI 组之间的手术和术后结局。使用 Kaplan-Meier 法和对数秩检验分析 3 年随访时的生存情况。Cox 回归用于识别与生存相关的变量。
30 天死亡率在两组间无差异（GNRI<92 组为 0.98%，GNRI≥92 组为 0.58%；p=0.54）。GNRI<92 组更频繁地需要透析（2.9%比 0.3%；p=0.04）、正性肌力药（33.3%比 22.8%；p=0.04）、红细胞输注（63.7%比 19.9%；p<0.01）和更长时间的机械通气支持（12±2 比 6±1.5 小时；p=0.03）。GNRI<92 组 ICU（4.7±0.9 比 1.6±0.8 天；p=0.05）和总术后住院时间（11.1±1.9 比 5.2±1.5 天；p=0.05）显著延长。
较差的营养状况可能会增加心脏手术后的发病率并延长住院时间。GNRI 可能会改善风险评估，并应整合到传统的手术风险模型中，为老年患者提供个性化的护理。
