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Nutritional indices for predicting prognosis in trauma: A systematic review and meta-analysis
Tianshu Mei1, Mengjiao Cui1, Ying Xia2
1Department of Emergency, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province 210008, China; China Hospital Reform and Development Research Institute of Nanjing University, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
Introduction:
Assessing the predictive value of nutritional indices in trauma patients could provide a scientific basis for clinical nutritional interventions.
Methods:
Eight databases, including PubMed and Embase, were searched up to January 19, 2025. Case-control and cohort studies involving adult trauma patients were included, with low nutritional risk as the experimental group and high risk as the control group. Primary outcomes were mortality, hospital length of stay (LOS), and complications. Study quality was assessed using the NIH tool, and statistical analysis was performed using STATA 15.0. Effect models were selected based on the I2 statistic, with results expressed as relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (CI). Sensitivity analysis and publication bias assessment were conducted.
Results:
Eighteen studies (11,275 patients) were included. Low nutritional indices were significantly associated with higher mortality (RR = 0.51; 95% CI: 0.36-0.72; P < 0.001), complications (RR = 0.68; 95% CI: 0.51-0.90; P = 0.008), and prolonged LOS (WMD = - 1.49; 95% CI: -2.20 to - 0.78; P < 0.001). Subgroup analysis showed the Mini Nutritional Assessment-Short Form (MNA-SF) had the strongest association with mortality, while the Prognostic Nutritional Index (PNI) was weakest. The Geriatric Nutritional Risk Index (GNRI) showed a non-significant trend for complications. Meta-regression indicated heterogeneity was not influenced by exposure type, sample size, or other factors. Sensitivity analysis confirmed robustness, with minimal publication bias.
Conclusions:
Nutritional indices effectively predict mortality, complications, and LOS in trauma patients, with higher scores linked to better outcomes, suggesting their utility as prognostic tools in trauma care.
