GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature

Lidoriki, Irene; Schizas, Dimitrios; Frountzas, Maximos; Machairas, Nikolaos; Prodromidou, Anastasia; Kapelouzou, Alkistis; Karavokyros, Ioannis; Pikoulis, Emmanouil; Kales, Stefanos N.; Liakakos, Theodoros

doi:10.1080/01635581.2020.1756350

Cited by 72 publications

(57 citation statements)

References 54 publications

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“…A possible explanation for this could be that patients in the present study had a better baseline clinical condition than patients in previous studies, and not only elderly or chronic kidney disease patients but also young or nonchronic kidney disease patients were included. It has been reported that GNRI is an independent prognostic factor for short-term in-hospital mortality in elderly patients with sepsis [36] since the 28-day mortality of very high-risk patients (GNRI < 82) has been increased sixfold [37]. Also, Wang et al emphasized that GNRI should be of concern to clinicians as a potential prognostic predictor of COVID-19 based on the recently published preliminary results [38].…”

Section: Discussionmentioning

confidence: 99%

Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19

Song

Wang

et al. 2020

Preprint

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Background: Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and explored the relationship between nutritional risk at admission and in-hospital mortality.Methods: A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission.Results: 295 patients were enrolled, including 66 severe patients and 41 critically ill patients. 25 deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI score, as well as higher CONUT, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality.Conclusions: Despite variant assessment tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.

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Section: Discussionmentioning

confidence: 99%

Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19

Song

Wang

et al. 2020

Preprint

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“…The GNRI has been validated to have a strong correlation with the mid-upper arm muscle circumference, arm muscle area, and handgrip strength of hospitalized patients [26], preoperative sarcopenia status of cancer patients [27], and MNA score [28]. The GNRI was reported to be a strong prognostic factor to assess the outcomes of various clinical conditions, including chronic kidney disease [29], heart failure [30], chronic obstructive pulmonary disease [31], chronic hemodialysis [32], and certain malignancies [33,34]. Serum albumin level has been recognized as a strong indicator of patients' nutritional status.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Huang

et al. 2020

IJERPH

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Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI < 82; group 1, n = 127), moderate-risk group (GNRI 82–92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI > 98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.

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“…This is associated with an elevated risk of all cause mortality in many human diseases such as diabetes mellitus, cardiovascular disease, end stage renal disease and various cancers ( Hao et al, 2019 ). Lidoriki et al concluded that low GNRI scores were associated with an increased risk for both developing postoperative complications and impaired survival in cancer patients, as seen by a systemic review of eighteen studies associated with GNRI and cancers ( Lidoriki et al, 2020 ). Lee et al conducted GNRI studies from a randomized controlled trial of extended-stage disease small cell lung cancer treated with etoposide plus cisplatin, finding that a low GNRI value was associated with systemic inflammation, nutritional status and a poor prognosis outcome ( Lee et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index as a Prognostic Marker for Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel

Chang

Hung

et al. 2021

Front. Pharmacol.

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Purpose: To investigate the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in patients with metastatic Castration–resistant Prostate Cancer (mCRPC) receiving docetaxel as the first line of treatment.Methods: We retrospectively reviewed patients with mCRPC and receiving first line docetaxel in Taichung Veterans General Hospital from 2006 to 2012. The GNRI was calculated using serum albumin and body mass index, with a poor nutritional status defined as GNRI <92.0. Multivariate Cox-regression analysis was used to evaluate the risk of survival.Results: One-hundred seventy patients with mCRPC were included. One-hundred twenty-five patients were of normal nutritional status (GNRI ≥92) and 45 patients were of poor nutritional status (GNRI <92). The cumulative docetaxel dosage was 600 (360–1,185) mg in the normal nutritional status group and 360 (127.5–660) mg in the poor nutritional status group (p < 0.001). The median overall survival from mCRPC was 30.39 months in the good nutritional status group and 11.07 months in the poor nutritional status group (p of log rank <0.001). In a multivariate model, poor nutritional status was an independent risk factor in overall survival (Hazard Ratio [HR] = 5.37, 95% Confidence Interval [CI] 3.27–8.83), together with a high metastatic volume (HR = 4.03, 95% CI 2.16–7.53) and docetaxel cumulative dosage (HR = 0.999, 95% CI 0.999–0.9998).Conclusion: Poor nutritional status with a GNRI <92 is associated with shorter progression free survival and overall survival in mCRPC patients treated with docetaxel. Metastatic volume and cumulative docetaxel dosage are also independent prognostic factors in overall survival.

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GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature

Cited by 72 publications

References 54 publications

Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19

Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Geriatric Nutritional Risk Index as a Prognostic Marker for Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel

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