Geriatric Nutritional Risk Index as a Prognostic Factor for Mortality in Elderly Patients with Moderate to Severe Traumatic Brain Injuries

Su, Wei-Ti; Tsai, Ching-Hua; Huang, Chun-Ying; Chou, Sheng-En; Li, Chi; Hsu, Shiun-Yuan; Hsieh, Ching-Hua

doi:10.2147/rmhp.s314487

Cited by 12 publications

(10 citation statements)

References 58 publications

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“…Prior studies using GNRI in trauma patients have demonstrated an association between GNRI and adverse clinical outcomes in geriatric trauma patients. Su et al 33 found an independent association between GNRI and mortality in geriatric patients with moderate to severe traumatic brain injury. Other studies corroborated this association between malnutrition and mortality as well as found an association between GNRI, prolonged hospital LOS, and poor functional outcomes 12,14,34 .…”

Section: Discussionmentioning

confidence: 99%

The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients

Kregel

Murphy²,

Attia³

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Malnutrition is associated with increased morbidity and mortality after trauma. The Geriatric Nutritional Risk Index (GNRI) is a validated scoring system used to predict the risk of complications related to malnutrition in nontrauma patients. We hypothesized that GNRI is predictive of worse outcomes in geriatric trauma patients. METHODS:This was a single-center retrospective study of trauma patients 65 years or older admitted in 2019. Geriatric Nutritional Risk Index was calculated based on admission albumin level and ratio of actual body weight to ideal body weight. Groups were defined as major risk (GNRI <82), moderate risk (GNRI 82-91), low risk (GNRI 92-98), and no risk (GNRI >98). The primary outcome was mortality. Secondary outcomes included ventilator days, intensive care unit length of stay (LOS), hospital LOS, discharge home, sepsis, pneumonia, and acute respiratory distress syndrome. Bivariate and multivariable logistic regression analyses were performed to determine the association between GNRI risk category and outcomes. RESULTS:A total of 513 patients were identified for analysis. Median age was 78 years (71-86 years); 24 patients (4.7%) were identified as major risk, 66 (12.9%) as moderate risk, 72 (14%) as low risk, and 351 (68.4%) as no risk. Injury Severity Scores and Charlson Comorbidity Indexes were similar between all groups. Patients in the no risk group had decreased rates of death, and after adjusting for Injury Severity Score, age, and Charlson Comorbidity Index, the no risk group had decreased odds of death (odds ratio, 0.13; 95% confidence interval, 0.04-0.41) compared with the major risk group. The no risk group also had fewer infectious complications including sepsis and pneumonia, and shorter hospital LOS and were more likely to be discharged home. CONCLUSIONS:Major GNRI risk is associated with increased mortality and infectious complications in geriatric trauma patients. Further studies should target interventional strategies for those at highest risk based on GNRI.

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Section: Discussionmentioning

confidence: 99%

The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients

Kregel

Murphy²,

Attia³

et al. 2022

J Trauma Acute Care Surg

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“…Kregel et al also identified that a low GNRI was associated with high mortality and increased infectious complaints among geriatric trauma patients ( 34 ). Moreover, the GNRI was identified to have satisfactory performance in predicting the clinical outcome of elderly severe TBI patients as well ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…The geriatric nutritional risk index (GNRI), calculated by actual weight, ideal weight, and serum albumin concentration, is a simple and accurate index that reflects the nutritional condition of elderly patients ( 14 , 15 ). Furthermore, Su et al identified that GNRI was also correlated with the clinical outcome of geriatric patients suffering from moderate to severe TBI ( 16 ). However, the correlation between the GNRI and the clinical outcome of elderly mTBI patients is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Poor nutritional status is associated with incomplete functional recovery in elderly patients with mild traumatic brain injury

Zhu

Guo

et al. 2023

Front. Neurol.

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BackgroundThe geriatric nutritional risk index (GNRI) is a simple index for evaluating the nutrition status of elderly patients. Many investigations have demonstrated that this index is associated with the prognosis of several diseases. This study aims to identify the relationship between the GNRI and recovery in elderly mild traumatic brain injury (mTBI) patients.MethodsA total of 228 mTBI patients older than 65 years were included in this study. mTBI was defined as an injury to the brain with a loss of consciousness of 30 min or less, a duration of posttraumatic amnesia of <24 h, and an admission Glasgow Coma Scale (GCS) score of 13–15. The Glasgow Outcome Scale Extended (GOSE), an outcome scale assessing functional independence, work, social activities, and personal relationships, was applied to assess the recovery of the patients. The clinical outcome was divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7) at 6 months after the injury. Multivariate logistic regression was applied to evaluate the association between the GNRI and recovery of elderly mTBI patients, with adjustment for age, sex, hypertension, diabetes, and other important factors.ResultsThe receiver operating curve (ROC) analysis demonstrated that the cutoff value of GNRI was 97.85, and the area under the curve (AUC) was 0.860. Compared to the patients with a high GNRI, the patients with a low GNRI were older, had a higher prevalence of anemia, acute subdural hematoma, and subarachnoid hemorrhage, had a higher age-adjusted Charlson Comorbidity Index value, and had lower levels of albumin, lymphocytes, and hemoglobin. Multivariable analysis showed that high GNRI was associated with a lower risk of 6-month incomplete recovery (OR, 0.770, 95% CI: 0.709–0.837, p < 0.001).ConclusionThe GNRI has utility as part of the objective risk assessment of incomplete 6-month functional recovery in elderly patients with mTBI.

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“…Geriatric patients with TBI, on average, experience higher mortality and morbidity rates, slower recovery, and worse outcomes than younger patients [ 63 ]. A previous study showed that the Geriatric Nutritional Risk Index is a significant independent risk factor for mortality in geriatric patients with moderate to severe TBI [ 64 ]. Although malnutrition is closely related to poor outcomes during hospitalization in geriatric patients, it remains common and underdiagnosed [ 65 ].…”

Section: Unresolved Issues and Future Research Directionsmentioning

confidence: 99%

Nutrition Management in Patients With Traumatic Brain Injury: A Narrative Review

Lee

2022

Brain Neurorehabil

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Traumatic brain injury (TBI) is a major cause of long-term physical and psychological disability and death. In patients with TBI, undernutrition is associated with an increased mortality rate, more infectious complications, and worse neurologic outcomes. Therefore, timely and effective nutritional therapy is particularly crucial in the management of TBI to improve patients’ prognoses. This narrative review summarizes the issues encountered in clinical practice for patients with neurotrauma who receive acute and post-acute in-patient rehabilitation services, and it comprehensively incorporates a wide range of studies, including recent clinical practice guidelines (CPGs), with the aim of better understanding the current evidence for optimal nutritional therapy focused on TBI patients. Recent CPGs were reviewed for 6 topics: 1) hypermetabolism and variation in energy expenditure in patients with TBI, 2) delayed gastric emptying and intolerance to enteral nutrition, 3) decision-making on the route and timing of access in patients with TBI who are unable to maintain volitional intake (enteral nutrition versus parenteral nutrition), 4) decision-making on the enteral formula (standard or immune-modulating formulas), 5) glycemic control, and 6) protein support. We also identified areas that need further research in the future.

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Geriatric Nutritional Risk Index as a Prognostic Factor for Mortality in Elderly Patients with Moderate to Severe Traumatic Brain Injuries

Cited by 12 publications

References 58 publications

The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients

The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients

Poor nutritional status is associated with incomplete functional recovery in elderly patients with mild traumatic brain injury

Nutrition Management in Patients With Traumatic Brain Injury: A Narrative Review

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