Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

Abstract

AimsThe aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD.MethodsThe data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC‐IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsA total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42–2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05).ConclusionsOur results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single‐center cohort and will need to be validated in future studies involving multiple centers.

The Geriatric Nutritional Risk Index is related to adverse hospitalization outcomes in individuals undergoing cardiac surgery

“…It serves as an indicator that re ects both overall nutrition and the severity of underlying diseases. Given that the metabolic process of the elderly primarily involves catabolism, necessitating more proteins to compensate for tissue protein consumption 34 , the decline in serum albumin may indicate a potential in ammatory response in cardiovascular disease. In comparison to other nutritional indicators, GNRI is regarded as a more precise predictor of outcomes related to nutrition in the elderly population.…”

Evaluating early lymphocyte-to-monocyte ratio as a predictive biomarker for delirium in older adult patients with sepsis: insights from a retrospective cohort analysis

“…Furthermore, a backward stepwise logistic regression approach (Model 5) was executed to procure the most parsimonious model, as indicated by the minimum Akaike Information Criterion (AIC) ( 16 ). The presence of collinearity among continuous variables was gauged using the variance inflation factor (VIF) ( 17 ), with any variable exhibiting a VIF exceeding 5 being excluded from the final model ( 18 ). Additionally, the relationship between LMR and delirium was graphically depicted using restricted cubic splines.…”