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Geriatric Nutritional Risk Index is Associated with Hospital Death in Elderly Patients with Multiple Organ

Zhi Mao1, Tao Wen1, Xiaoli Liu2

  • 1Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.

Frontiers in Nutrition
|June 20, 2022
PubMed
Abstract

Insights

Elderly patients with multiple organ dysfunction syndrome (MODS) face higher mortality. Baseline nutritional status, assessed by geriatric nutritional risk index (GNRI), significantly impacts survival, with malnutrition increasing death risk.

Area of Science:

  • Geriatric Medicine
  • Critical Care Medicine
  • Nutritional Science

Background:

  • Elderly patients in intensive care units (ICUs) often experience multiple organ dysfunction syndrome (MODS).
  • Malnutrition is a common comorbidity in elderly patients, potentially exacerbating MODS outcomes.
  • Baseline nutritional status is a critical factor influencing hospitalization mortality in this vulnerable population.

Purpose of the Study:

  • To investigate the association between baseline nutritional status and in-hospital mortality among elderly patients diagnosed with MODS.
  • To analyze the impact of nutritional risk, quantified by the geriatric nutritional risk index (GNRI), on mortality outcomes in elderly MODS patients.

Main Methods:

  • Utilized the MIMIC-III database to screen and enroll elderly patients with MODS.
  • Calculated the geriatric nutritional risk index (GNRI) to categorize patients into normal nutrition and varying degrees of malnutrition.
  • Employed Generalized Additive Models (GAM) to assess the relationship between GNRI and mortality, identifying threshold effects.
  • Conducted multivariate logistic regression and subgroup analyses to determine the independent association of GNRI with in-hospital death.

Main Results:

  • A total of 2456 elderly patients with MODS were analyzed, with 51.8% in the normal nutrition group and 48.2% in the malnutrition group.
  • Patients in the malnutrition group exhibited a significantly higher mortality rate compared to those with normal nutrition (48.2% vs. 20.4%, P < 0.001).
  • GAM analysis revealed a threshold saturation effect at GNRI = 92; mortality risk was associated with GNRI values below 92, with higher GNRI correlating to lower risk. Male patients showed a lower risk of death than female patients within the GNRI < 92 subgroup.

Conclusions:

  • The geriatric nutritional risk index (GNRI) is a significant indicator of illness severity and mortality risk in elderly patients with MODS.
  • Moderate to severe malnutrition (GNRI < 92) substantially increases the risk of in-hospital death in elderly patients with MODS.
  • Nutritional status is a modifiable factor that warrants attention for improving outcomes in elderly MODS patients.
Keywords:
MIMIC-IIIelderlygeriatric nutritional risk indexintensive care unitmultiple organ dysfunction syndrome

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