Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma

Abstract

Background: Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. Methods: From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92–98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. Results: The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83–0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04–1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91–0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. Conclusions: This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.

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

“…While numerous prior studies have demonstrated this link between nutrition and poor clinical outcomes, the optimal method to diagnose malnutrition remains unclear. The GNRI has been prospectively validated in multiple populations, including patients undergoing abdominal surgery 8–11,13,31 . This index was developed specifically as a predictive tool for nutrition-related complications rather than as a diagnostic tool for malnutrition 7,32 .…”

“…The GNRI has been prospectively validated in multiple populations, including patients undergoing abdominal surgery. [8][9][10][11]13,31 This index was developed specifically as a predictive tool for nutrition-related complications rather than as a diagnostic tool for malnutrition. 7,32 With only three objective parameters required for calculation, the score is easy to calculate in an acute setting and has no subjective measures that require patient or caregiver participation, thus eliminating the bias caused by reporting.…”

“…[8][9][10][11] The populations in which this scoring index has been validated have since been expanded, and the GNRI has been shown to be predictive of complications in a large variety of surgical procedures, including orthopedic, surgical oncology, colorectal, and general surgery, but it has been applied to trauma patients in a limited number of studies. 9,[12][13][14][15][16] In this study, we aimed to define the prevalence and severity of malnutrition in geriatric trauma patients using GNRI and to evaluate the association between GNRI and clinical outcomes. We hypothesized that the GNRI can be used to screen geriatric trauma patients and that a low GNRI (high risk of malnutrition) would be associated with worse clinical outcomes.…”

From Death Triad to Death Tetrad—The Addition of a Hypotension Component to the Death Triad Improves Mortality Risk Stratification in Trauma Patients: A Retrospective Cohort Study

“…However, GCS may be considered as a choice for add-on in the death triad to stratify patients who are at risk of mortality. One study used GCS instead of temperature as the BIG (base deficit [B], international normalized ratio [I], and GCS [G]) score for predicting mortality in pediatric trauma [ 23 ]. The predictive power was comparable with that of more complex systems, such as pediatric logistic organ dysfunction, Pediatric Index of Mortality 2, and Pediatric Risk of Mortality III [ 28 ].…”

“…The study included information on age, sex, comorbidities (including coronary artery disease (CVA), congestive heart failure (CHF), hypertension (HTN), diabetes mellitus (DM), and end-stage renal disease (ESRD)), vital signs, PH, INR, Glasgow Coma Scale (GCS) score, abbreviated injury scale (AIS) in each body region, injury severity score (ISS), in-hospital mortality, length of hospital stay (LOS), and admission into the intensive care unit (ICU). The polytrauma is defined as the trauma patients have injuries of AIS ≥ 3 in more than one body region [ 22 , 23 ].…”