Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index

Chohan, Karan; Park, Jeff; Dales, Sarah; Varughese, Rhea; Wickerson, Lisa; Singer, L.G.; Stewart, Brooke; Rozenberg, Dmitry

doi:10.1097/txd.0000000000001028

Cited by 12 publications

(12 citation statements)

References 61 publications

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“…Furthermore, the variables with non-zero coefficients in the fitted LASSO model were considered significant predictors. Candidate predictors selected through the LASSO method were used to construct a multivariate logistic regression model, and the Akaike Information Criterion (AIC) was referenced to find the optimal prediction model ( 12 ). The above analysis was performed using function glm in the “stats” package and function stepAIC in the “MASS” package.…”

Section: Methodsmentioning

confidence: 99%

Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients

Chen

Zhong

et al. 2022

Front. Nutr.

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BackgroundThe geriatric nutritional risk index (GNRI) is a commonly used method to assess nutritional risk for predicting potential surgical site infections (SSI) in cancer patients. This study aims to create and verify a simple nomogram and a dynamic web-based calculator for predicting the risk of SSI among gynecologic oncology patients.MethodsA retrospective evaluation was conducted on patients who were admitted into a tertiary hospital in China with confirmed diagnosis of gynecologic cancer between 01 August 2017 and 30 November 2021. A two-piecewise linear regression model with a smoothing function was used to investigate the non-linear association between GNRI and SSI to determine the ideal cut-off point. Three models were developed on the basis of different variables to predict SSI in gynecologic oncology patients. Through a nomogram the concordance index (C-index), the Akaike information criterion (AIC), and the integrated discrimination index (IDI) were used to determine the final model. Finally, the performance of the nomogram was validated using the 1,000-bootstrap resamples method and analyzed using C-index, GiViTI calibration belts, and decision curve. Also, a user-friendly dynamic web-based calculator was developed.ResultsA total of 1,221 patients were included in the analysis. A non-linear association could be observed between GNRI and SSI risk with a GNRI cut-off value of 101.7. After adding GNRI to Model 2 (which comprised Morse Fall Scale score, preoperative length of stay, operation time, and estimated blood loss), the AIC value decreased, the C-index value increased and IDI increased significantly. The nomogram C-index in the development cohort and internal validation cohort demonstrates a moderate-high degree of discrimination. The GiViTI calibrated belt showed a good agreement between the observed and predicted probabilities of SSI. The decision curve validates the clinical feasibility of the nomogram with a threshold value between 0 and 49%.ConclusionThe GNRI cut-off value of 101.7 allowed for appropriate stratification of patients into distinct SSI risk groups. This study found that including GNRI in the above nomogram (Model 2) would enhance its potential to predict SSI in gynecologic oncology patients.

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Section: Methodsmentioning

confidence: 99%

Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients

Chen

Zhong

et al. 2022

Front. Nutr.

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“…The exercise sessions were comprised of aerobic, resistance and flexibility training with progression and intensity previously described (19). In addition, LTx candidates underwent nutritional assessment by a dietitian prior to listing and were provided with dietary counselling at our center as needed (23).…”

Section: Pre-transplant Rehabilitation Programmentioning

confidence: 99%

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

Minuk¹,

Chohan²,

Kumbhare³

et al. 2023

Ann Palliat Med

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Background: Lung transplant (LTx) candidates experience significant respiratory symptoms often necessitating palliative care (PC) support. We aimed to describe symptoms experienced by interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) LTx candidates referred for PC using the Edmonton Symptom Assessment Scale (ESAS) and to assess the change in ESAS in relation to pre-LTx exercise capacity, oxygen requirements, and respiratory exacerbations. Understanding symptom trajectory of these two patient groups will help inform PC management. Methods: Single centre, retrospective cohort of 102 ILD and 24 COPD LTx candidates who were assessed in the Toronto Transplant PC Clinic (TPCC) from 2014-2017. Chi-square and t-tests were used to compare clinical characteristics, physiological parameters, and ESAS scores. Results:The most common symptom in ILD and COPD patients was dyspnea (median score of 8, cough 7, fatigue 6). ILD patients reported higher cough scores (7 vs. 4, P<0.001). There was no association between the change in ESAS domains and six-minute walk distance (6MWD), oxygen requirements, or respiratory exacerbations, despite increased oxygen requirements and a greater decline in 6MWD in ILD compared to COPD pre-LTx (−47 vs. −8 meters, P=0.01). ILD candidates who were delisted/died compared to those transplanted, experienced worse depression (median ESAS; 4.5 vs. 1), anxiety (5.5 vs. 2) and dyspnea (9.5 vs. 8); P<0.05.Conclusions: ILD patients had similar symptoms as COPD patients, despite increased oxygen requirements and decreasing 6MWD pre-LTx. This study highlights the importance of symptom management of LTx candidates co-managed with PC, independent of traditional measures of disease severity.

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“…Whether the low BMI in patients with PPFE results from malnutrition and affects post-LT outcomes should be investigated in further studies. Other parameters that reflect frailty or the nutritional status, such as the muscle mass [ 33 ], bioelectrical impedance analysis results [ 34 ], and nutritional risk index [ 35 ], should also be evaluated in future studies. Moreover, severe restrictive dysfunction in patients with PPFE might result in increased respiratory effort and energy consumption.…”

Section: Clinical Characteristics Of Ppfementioning

confidence: 99%

Lung Transplantation for Pleuroparenchymal Fibroelastosis

Shiiya

Sato

2021

JCM

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Pleuroparenchymal fibroelastosis (PPFE), a new disease entity associated with interstitial pneumonia, is characterized by fibrosis and elastosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobe. As the awareness of this disease entity has increased, many studies have revealed the prevalence and incidence, clinical and pathological characteristics, and disease course of PPFE. Patients with PPFE reportedly have several unique clinical characteristics—including an extremely low body mass index with a slender body and chest wall deformity, known as “flat chest”. As this disease progresses, shrinking of the lungs often causes life-threatening complications, such as pneumothorax, and associated air leak syndrome. Lung transplantation is considered the only effective treatment for patients with advanced PPFE; however, little is known about the influences of the characteristics of PPFE on the outcome of lung transplantation. This review focuses on the unique clinicopathologic characteristics of PPFE and associated outcomes of lung transplantation for these patients.

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Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index

Abstract: Supplemental Digital Content is available in the text.

Cited by 12 publications

References 61 publications

Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients

Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

Lung Transplantation for Pleuroparenchymal Fibroelastosis

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