Hang-Tsung Liu1, Shao-Chun Wu2, Ching-Hua Tsai1, Chi Li1, Sheng-En Chou1, Wei-Ti Su1, Shiun-Yuan Hsu1, Ching-Hua Hsieh3. 1. Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan. 2. Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan. 3. Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan.
Abstract
The geriatric nutritional risk index (GNRI) is a simple and efficient tool to assess the nutritional status of patients with malignancies or after surgery. Because trauma patients constitute a specific population that generally acquires accidental and acute injury, this study aimed to identify the association between the GNRI at admission and mortality outcomes of older trauma patients in the intensive care unit (ICU). METHODS: The study population included 700 older trauma patients admitted to the ICU between 1 January 2009 and 31 December 2019. The collected data included age, sex, body mass index (BMI), albumin level at admission, preexisting comorbidities, injury severity score (ISS), and in-hospital mortality. Multivariate logistic regression analysis was conducted to identify the independent effects of univariate predictive variables resulting in mortality in our study population. The study population was categorized into four nutritional risk groups: a major-risk group (GNRI < 82; n = 128), moderate-risk group (GNRI 82 to <92; n = 191), low-risk group (GNRI 92-98; n = 136), and no-risk group (GNRI > 98; n = 245). RESULTS: There was no significant difference in sex predominance, age, and BMI between the mortality (n = 125) and survival (n = 575) groups. The GNRI was significantly lower in the mortality group than in the survival group (89.8 ± 12.9 vs. 94.2 ± 12.0, p < 0.001). Multivariate logistic regression analysis showed that the GNRI (odds ratio-OR, 0.97; 95% confidence interval (CI) 0.95-0.99; p = 0.001), preexisting end-stage renal disease (OR, 3.6; 95% CI, 1.70-7.67; p = 0.001), and ISS (OR, 1.1; 95% CI, 1.05-1.10; p < 0.001) were significant independent risk factors for mortality. Compared to the patients in group of GNRI > 98, those patients in group of GNRI < 82 presented a significantly higher mortality rate (26.6% vs. 13.1%; p < 0.001) and length of stay in hospital (26.5 days vs. 20.9 days; p = 0.016). CONCLUSIONS: This study demonstrated that GNRI is a significant independent risk factor and a promising simple screening tool to identify the subjects with malnutrition associated with higher risk for mortality in those ICU elderly trauma patients.
The geriatric nutritional risk index (GNRI) is a simple and efficient tool to assess the nutritional status of patients with malignancies or after surgery. Because traumapatients constitute a specific population that generally acquires accidental and acute injury, this study aimed to identify the association between the GNRI at admission and mortality outcomes of older traumapatients in the intensive care unit (ICU). METHODS: The study population included 700 older traumapatients admitted to the ICU between 1 January 2009 and 31 December 2019. The collected data included age, sex, body mass index (BMI), albumin level at admission, preexisting comorbidities, injury severity score (ISS), and in-hospital mortality. Multivariate logistic regression analysis was conducted to identify the independent effects of univariate predictive variables resulting in mortality in our study population. The study population was categorized into four nutritional risk groups: a major-risk group (GNRI < 82; n = 128), moderate-risk group (GNRI 82 to <92; n = 191), low-risk group (GNRI 92-98; n = 136), and no-risk group (GNRI > 98; n = 245). RESULTS: There was no significant difference in sex predominance, age, and BMI between the mortality (n = 125) and survival (n = 575) groups. The GNRI was significantly lower in the mortality group than in the survival group (89.8 ± 12.9 vs. 94.2 ± 12.0, p < 0.001). Multivariate logistic regression analysis showed that the GNRI (odds ratio-OR, 0.97; 95% confidence interval (CI) 0.95-0.99; p = 0.001), preexisting end-stage renal disease (OR, 3.6; 95% CI, 1.70-7.67; p = 0.001), and ISS (OR, 1.1; 95% CI, 1.05-1.10; p < 0.001) were significant independent risk factors for mortality. Compared to the patients in group of GNRI > 98, those patients in group of GNRI < 82 presented a significantly higher mortality rate (26.6% vs. 13.1%; p < 0.001) and length of stay in hospital (26.5 days vs. 20.9 days; p = 0.016). CONCLUSIONS: This study demonstrated that GNRI is a significant independent risk factor and a promising simple screening tool to identify the subjects with malnutrition associated with higher risk for mortality in those ICU elderly traumapatients.
Entities:
Keywords:
elderly; intensive care unit; malnutrition; mortality; the geriatric nutritional risk index; trauma
Authors: Heather R Kregel; Patrick B Murphy; Mina Attia; David E Meyer; Rachel S Morris; Ezenwa C Onyema; Sasha D Adams; Charles E Wade; John A Harvin; Lillian S Kao; Thaddeus J Puzio Journal: J Trauma Acute Care Surg Date: 2022-03-14 Impact factor: 3.697