Dataset Information

Inflammatory geriatric nutritional risk index stratified the survival of older adults with cancer sarcopenia.

ABSTRACT:

Background

Aging is accompanied by muscle loss. In older adults with cancer sarcopenia (OACS), systemic inflammation, reduced food intake, and reduced physical activity led to a poor prognosis. This study was to investigate the prognostic ability of the inflammatory Geriatric Nutritional Risk Index (GNRI), which combines patient's inflammation, diet status, and physical activity status to predict overall survival of OACS.

Methods

This prospective multi-center study enrolled 637 OACS, with an average age of 72.78 ± 5.98 years, of which 408 (64.1%) were males. We constructed the Inflammatory Functional Prognostic Index (IFPI) of OACS based on inflammatory GNRI scores, reduced food intake, and reduced physical activity. According to the IFPI, OACS was divided into high-, moderate-, and low-risk groups. Univariate and multivariate survival analyses analyzed the prognostic ability of the clinical parameters.

Results

Compared with OACS with a high GNRI score, the 1-, 3-, and 5-year hazard ratios (95% confidence interval) of OACS with a low GNRI score was 1.816 (1.076-3.063), 1.678 (1.118-2.518), and 1.627 (1.101-2.407), respectively. This result was consistent with that of the calibration curve. The subgroup analysis showed that the low GNRI score had a significant positive relation with patients with gastrointestinal cancer (P_interaction < 0.001). Notably, the survival analysis of IFPI showed that the mortality risk of moderate- and high-risk patients was 1.722-and 2.509-fold higher, respectively, than that of low-risk patients.

Conclusion

The GNRI score was a short-term and long-term inflammatory prognostic indicator for OACS. The IFPI score could improve patient survival prediction.

SUBMITTER: Ruan GT

PROVIDER: S-EPMC10067041 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Inflammatory geriatric nutritional risk index stratified the survival of older adults with cancer sarcopenia.

Ruan Guo-Tian GT Xie Hai-Lun HL Zhang He-Yang HY Zhang Qi Q Zhang Xi X Ge Yi-Zhong YZ Hu Chun-Lei CL Tang Meng M Song Meng-Meng MM Zhang Xiao-Wei XW Yang Ming M Yu Kai-Ying KY Gong Yi-Zhen YZ Deng Li L Shi Han-Ping HP

Cancer medicine 20221129 6

<h4>Background</h4>Aging is accompanied by muscle loss. In older adults with cancer sarcopenia (OACS), systemic inflammation, reduced food intake, and reduced physical activity led to a poor prognosis. This study was to investigate the prognostic ability of the inflammatory Geriatric Nutritional Risk Index (GNRI), which combines patient's inflammation, diet status, and physical activity status to predict overall survival of OACS.<h4>Methods</h4>This prospective multi-center study enrolled 637 OA ...[more]

PMID: 36444689

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Project description:BackgroundInvasive candidiasis is the most common hospital-acquired fungal infection in intensive care units (ICU). The Geriatric Nutritional Risk Index (GNRI) score was developed to evaluate the nutritional status of elderly adults. We aimed to assess the association between the GNRI score and the risk of invasive candidiasis in elderly patients admitted to ICU.MethodsHospitalization information of elderly patients with invasive candidiasis was collected retrospectively from Medical Information Mart for Intensive Care (MIMIC) IV and MIMIC-III Clinical Database CareVue subset from 2001 to 2019. The main outcome of this study was the diagnosis of invasive candidiasis in patients. We employed a multivariable Cox regression and propensity score matching to balance the influence of confounding factors on the outcome. Furthermore, we conducted sensitivity analyses by categorizing the GNRI into classes based on thresholds of 98, 92, and 81.ResultsA total of 6739 patients were included in the study, among whom 134 individuals (2%) were diagnosed with invasive candidiasis. The GNRI scores of patients with invasive candidiasis upon admission to the ICU were significantly lower, measuring 88.67 [79.26-98.27], compared to the control group with a score of 99.36 [87.98-110.45] (P < 0.001). The results of the multivariable Cox regression analysis demonstrated a strong association between higher GNRI scores and a decreased risk of invasive candidiasis infection (HR: 0.98, 95% CI: 0.97-0.99, P = 0.002). Consistently, similar results were obtained when analyzing the propensity score-matched cohort (HR: 0.99, 95% CI: 0.98-1, P = 0.028). Sensitivity analyses further confirmed a significantly increased risk of invasive candidiasis infection with lower GNRI scores. Specifically, the following associations were observed: GNRI ≤ 98 (HR: 1.83, 95% CI: 1.23-2.72, P = 0.003), GNRI ≤ 92 (HR: 1.68, 95% CI: 1.17-2.4, P = 0.005), 82 ≤ GNRI ≤ 92 (HR: 1.63, 95% CI: 1.01-2.64, P = 0.046), GNRI ≤ 81 (HR: 2.31, 95% CI: 1.44-3.69, P < 0.001).ConclusionsLower GNRI score was significantly associated with an increased risk of invasive candidiasis in elderly patients in ICU. Further research is needed to validate whether improving nutrition can prevent invasive candidiasis.

Project description:ObjectiveStandard modalities recommended for sarcopenia diagnosis may be unavailable in primary care settings. We aimed to comprehensively evaluate and compare associations of some better popularized nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis in community-dwelling middle-aged and elderly adults, including geriatric nutrition risk index (GNRI), albumin (ALB), calf circumference (CC), mid-arm circumference (MAC), triceps skinfold thickness (TST) and body mass index (BMI).MethodsBased on the West China Health and Aging Trend study, the current study included participants aged 50 or older who were recruited in 2018. Sarcopenia-related assessment and diagnosis were in line with Asian Working Group for Sarcopenia 2019. For each single index, we assessed its association with sarcopenia presence by univariate and multivariate logistic regression analysis; we also computed diagnostic measures including the area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, accuracy at the optimal cut-off value determined according to Youden's index.ResultsA total of 3829 subjects were included, consisting of 516 and 3313 subjects in the sarcopenia and non-sarcopenia groups, respectively. Regarding the risk for sarcopenia presence, the fully adjusted odds ratios of GNRI, ALB, CC, MAC, TST and BMI per standard deviation decrease were 2.95 (95% CI 2.51-3.47, P < 0.001), 1.01 (95% CI 0.90-1.15, P = 0.816), 4.56 (95% CI 3.82-5.44, P < 0.001), 4.24 (95% CI 3.56-5.05, P < 0.001), 1.67 (95% CI 1.92-1.45, P < 0.001) and 4.09 (95% CI 3.41-4.91, P < 0.001), respectively. Regarding the value in sarcopenia diagnosis in the entire study population, their AUCs could be ordered as MAC (0.85, 95% CI 0.83-0.86) > GNRI (0.80, 95% CI 0.78-0.82), CC (0.83, 95% CI 0.81-0.85), BMI (0.81, 95% CI 0.79-0.83) > TST (0.72, 95% CI 0.70-0.74) > ALB (0.62, 95% CI 0.60-0.65). At the relevant optimal cut-off values, the sensitivity was the highest for CC (0.83, 95% CI 0.80-0.87) and MAC (0.80, 95% CI 0.77-0.84), while GNRI showed the highest specificity (0.79, 95% CI 0.78-0.81) and accuracy (0.78, 95% 0.76-0.79).ConclusionOverall diagnostic performance was the best for MAC, followed by GNRI, CC, BMI, and the worst for TST, ALB in distinguishing sarcopenia from non-sarcopenia in middle-aged and elderly adults in community-based settings. CC or MAC might do better in reducing missed diagnosis, while GNRI was superior in reducing misdiagnosis.

Project description:IntroductionMalnutrition is a major contributor to poor treatment and survival outcomes in pancreatic cancer, yet nutritional assessment is not standardized or consistently implemented in the care of oncology patients. The Geriatric Nutritional Risk Index (GNRI), calculated from serum albumin and body weight, may be useful as a practical tool for identifying patients at risk of poor nutritional status. Purpose: To provide a preliminary analysis using a limited selection of variables to examine the association of the GNRI at diagnosis and the GNRI change over time with overall survival in patients with pancreatic cancer.MethodsThis retrospective study included 314 patients aged ≥18 years with pancreatic cancer. The GNRI was calculated at diagnosis and ≥30 days later. Patients were categorized by the GNRI at diagnosis (no risk >98, any risk ≤98) and change in the GNRI over time (no change/increase, mild decrease, and severe decrease). Additional variables included were demographics and stage. Comparative analysis included t-tests, chi-square tests, and ANOVA. Survival was analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling.ResultsMedian survival was significantly decreased in patients in the any-nutritional-risk group compared to the no-nutritional-risk group at diagnosis (442 vs. 1105 days), and those experiencing severe decreases in the GNRI scores compared to mild decreases and no change or increases (372.5 vs. 712 vs. 1791 days), respectively. Survival analysis stratified by the GNRI at diagnosis shows that both mild (HR 2.19, 95%, and CI 1.46-3.30) and severe decreases (HR 4.04, 95%, and CI 2.64-6.18) in the GNRI scores were independently associated with decreased survival versus no change or increase in the GNRI group after controlling for stage. Log-rank tests also show patients with any nutritional risk at diagnosis had significantly lower survival than those with no nutritional risk (p = 0.00052).ConclusionsLower GNRI scores showing greater nutritional risk at diagnosis and decreasing GNRI scores over time were predictors of decreased survival in pancreatic cancer. Our findings indicate that the GNRI may be valid and effective for the early identification of patients with a high nutritional risk who require nutritional interventions to improve outcomes in pancreatic cancer. However, more research is needed using larger samples and a greater variety of variables to confirm the presence and strength of this relationship, examine the effect of patient factors known to be associated with survival and nutrition, and explore potential influential confounders.

Project description:BackgroundWe aimed to explore the association between the Geriatric Nutritional Risk Index (GNRI) and the risk of low cognitive functions among older adults in the United States (US).MethodsUtilizing data from the National Health and Nutrition Examination Study (NHANES) database, a cross-sectional analysis was conducted. The GNRI served as a tool for evaluating the nutritional status of participants, who were categorized into two groups based on their initial GNRI scores: those with scores >98 indicating normal nutrition, and those with scores ≤98 indicating malnutrition. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's disease word list learning test (CERAD W-L), the Digit Symbol Substitution Test (DSST), the Animal Fluency Test (AFT), and the composite-z score which was calculated by summing the z scores of individual tests, respectively. Weighted multiple logistic regression models were used to evaluate the association between GNRI and cognitive function. Interaction and stratified analyses were conducted.ResultsAmong a sample of 2,925 individuals aged 60 years or older, 51.3% were women. Among these individuals, 233 were identified as malnourished. Weighted multivariate logistic regression analyses indicated that individuals with malnutrition had an increased risk of low cognitive function, as evidenced by lower CERAD W-L scores (OR:1.68, 95%CI 1.19-2.36, p = 0.003), AFT scores (OR: 1.74, 95%CI 1.26-2.41, p = 0.009), DSST scores (OR:1.63, 95%CI 1.11-2.38, p = 0.012), or composite z-scores (OR:1.87, 95%CI 1.29-2.71, p = 0.001). According to the variables evaluated, the interaction effects between low GNRI level and the elderly and stroke in specific cognitive domains were significant (P interaction < 0.05).ConclusionLower GNRI level is associated with significantly low cognitive function among older adults, particularly among those who have experienced a stroke or the elderly (aged 70 years and older) population.

Dataset Information

Inflammatory geriatric nutritional risk index stratified the survival of older adults with cancer sarcopenia.

Background

Methods

Results

Conclusion

Publications

Inflammatory geriatric nutritional risk index stratified the survival of older adults with cancer sarcopenia.

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