老年营养风险指数对脓毒症相关急性肾损伤患者短期预后的影响：基于MIMIC-IV数据库的分析
Impact of the Geriatric Nutritional Risk Index on short-term prognosis of patients with sepsis-related acute kidney injury: analysis using the MIMIC-IV database.
作者信息
Cai Kailun, Mao Wenchao, Yang Mingkun, Chen Changqin, Gong Shijin, Zheng Lifen, Zhao Changyun
机构信息
Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, Zhejiang, 310013, China.
Department of Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, 310053, China.
出版信息
BMC Nephrol. 2025 Apr 23;26(1):205. doi: 10.1186/s12882-025-04122-2.
BACKGROUND
In critically ill elderly patients, malnutrition is a common comorbidity. The Geriatric Nutritional Risk Index (GNRI) is a straightforward tool for evaluating the nutritional status of elderly individuals. The association between GNRI score and unfavorable health outcomes has been established. However, no studies have yet elucidated the relationship between GNRI score and sepsis-related acute kidney injury (S-AKI).
METHODS
We sourced patient data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All patients were divided into four groups based on their GNRI score using quartile analysis. The main objective of this study was to investigate the 28-day mortality rate. Secondary study outcomes were the incidence of severe AKI, length of stay in the intensive care unit, and days in the hospital. To evaluate the association between GNRI score and study outcomes, we used a Cox proportional hazards regression model and restricted cubic splines. Kaplan-Meier curves were used to compare the outcomes in each group.
RESULTS
A total of 4515 elderly patients with S-AKI were included in this study. Patients were categorized into four groups according to GNRI quartile: Q1 (< 78.92), Q2 (78.92-84.88), Q3 (84.88-90.84), and Q4 (> 90.84). Overall 28-day mortality was 29.5%. Patients with a low GNRI were predominantly women, and had a low body mass index. After controlling for confounding factors, GNRI score emerged as an independent predictor of 28-day mortality among elderly patients with S-AKI (Q4 vs. Q1: hazard ratio 0.74, 95% confidence interval 0.63-0.87; p < 0.001). Restricted cubic spline analysis revealed a linear relationship between GNRI and 28-day mortality (p for non-linearity = 0.207), and this association remained consistent across all subgroup analyses.
CONCLUSIONS
The GNRI is an important nutritional assessment tool, and is useful in predicting the prognosis of critically ill elderly patients with S- AKI.
背景
在危重症老年患者中，营养不良是一种常见的合并症。老年营养风险指数（GNRI）是评估老年人营养状况的一种简单工具。GNRI评分与不良健康结局之间的关联已经确立。然而，尚无研究阐明GNRI评分与脓毒症相关急性肾损伤（S-AKI）之间的关系。
方法
我们从重症监护医学信息数据库IV（MIMIC-IV）中获取患者数据。使用四分位数分析根据GNRI评分将所有患者分为四组。本研究的主要目的是调查28天死亡率。次要研究结局包括严重急性肾损伤的发生率、重症监护病房住院时间和住院天数。为了评估GNRI评分与研究结局之间的关联，我们使用了Cox比例风险回归模型和受限立方样条。采用Kaplan-Meier曲线比较各组的结局。
结果
本研究共纳入4515例患有S-AKI的老年患者。根据GNRI四分位数将患者分为四组：Q1（<78.92）、Q2（78.92-84.88）、Q3（84.88-90.84）和Q4（>90.84）。总体28天死亡率为29.5%。GNRI低的患者以女性为主，且体重指数较低。在控制混杂因素后，GNRI评分成为患有S-AKI的老年患者28天死亡率的独立预测因素（Q4与Q1相比：风险比0.74，95%置信区间0.63-0.87；p<0.001）。受限立方样条分析显示GNRI与28天死亡率之间存在线性关系（非线性p=0.207），并且这种关联在所有亚组分析中均保持一致。
结论
GNRI是一种重要的营养评估工具，有助于预测患有S-AKI的危重症老年患者的预后。
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