The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients. J Trauma Acute Care Surg 2022 Aug 01;93(2):195-199
Date
03/17/2022Pubmed ID
35293374Pubmed Central ID
PMC9329178DOI
10.1097/TA.0000000000003588Scopus ID
2-s2.0-85135383083 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
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.
LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.
Author List
Kregel HR, Murphy PB, Attia M, Meyer DE, Morris RS, Onyema EC, Adams SD, Wade CE, Harvin JA, Kao LS, Puzio TJAuthors
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of WisconsinPatrick Murphy MD Assistant Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedGeriatric Assessment
Humans
Malnutrition
Nutrition Assessment
Nutritional Status
Prospective Studies
Retrospective Studies
Risk Factors
Sepsis
