Association between Geriatric Nutritional Risk Index and Mortality in Older Trauma Patients in the Intensive Care Unit

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 as a predictor of complications 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 . With this study, we have identified a population that can be identified early in the hospital course as high risk for poor clinical outcomes.…”

“…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 With this study, we have identified a population that can be identified early in the hospital course as high risk for poor clinical outcomes. Accordingly, this population may benefit from early interventions of nutrition as a modifiable risk factor.…”

Comparing Outcomes between Major Trauma Patients Transferred from a Different Hospital and Patients Transported Directly to Trauma Centers: A Retrospective Analysis with Propensity Score Matching Analysis

“…This is contradictory to some US studies which demonstrated that patients with major trauma taken directly to a trauma center had lower mortality than those seen at other hospitals and subsequently referred to a trauma center for definitive care [ 4 , 11 ]. In Taiwan, most traffic accidents are motorcycle accidents that occur in relatively crowded streets, and the transport times of patients to the emergency room are short (average 12 min for Taipei according to government data [ 12 ] and 18 min for Kaohsiung according to our previous analysis) [ 13 , 14 ]. Therefore, we believe that the short transportation time from the accident scene to the emergency room may partly explain why there was no significant difference in the mortality rate between the patients who were transferred from other hospitals and those transported directly to trauma centers first.…”

Nutrition therapy in the older critically ill patients: A scoping review

“…9 Malnutrition risk defined by MUST was associated with higher mortality at 1-year post-discharge. 11 Biochemical derangement measured by GNRI was associated with mortality (hospital or 30-day) and hospital LOS, 10,13,14 but not associated with ICU mortality and ICU LOS. 15 Similarly, biochemical derangements measured by CONUT and PNI were not associated with ICU mortality.…”