Dataset Information

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort.

ABSTRACT:

Objective

To determine whether the Geriatric Nutritional Risk Index (GNRI) on hospital admission was associated to an increased 14-day and 12-month mortality-risk in older inpatients with COVID-19.

Methods

Cohort study of consecutive inpatients admitted with COVID-19 in a university hospital (20/03/2020-11/05/2021).

Inclusion criteria

age over 65 years and positive polymerase chain reaction test.

Exclusion criteria

missing data for weight, height, and/or albumin, hospital-acquired COVID-19, or patients transferred to other health facilities.

Outcome

all-cause mortality at 14-day and 12-month follow-up. GNRI [1.489 × albumin (g/L)] + [41.7 (weight/ideal body weight)] was assessed at admission; scores ≤98 indicated risk of malnutrition. Cox-proportional hazards models assessed the association between the admission GNRI and 14-day and 12-month mortality-risk, after adjusting by demographic and clinical variables, including inflammation (C-reactive protein).

Results

Of the 570 eligible patients, 224 (mean age 78 years; 52.2% women) met inclusion criteria and 151 (67.4%) were classified at risk of malnutrition. Twenty patients died during the 14-day and 42 during the 12-month follow-up. The risk of 14-day mortality was nearly 10 times higher in patients with GNRI scores ≤98 (HR = 9.6 [95%CI 1.3-71.6], P = 0.028); this association was marginally significant in the adjusted model (HR = 6.73 [95%CI 0.89-51.11], P = 0.065)]. No association between GNRI and the 12-month mortality-risk was found.

Conclusions

The GNRI may play a role in the short-term prognosis of older inpatients with COVID-19. Further studies are required to confirm the short-term predictive validity of the GNRI within this population (Clinicaltrials.gov_NCT05276752).

SUBMITTER: De Meester D

PROVIDER: S-EPMC10290730 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort.

De Meester Dorien D Goossens Mathijs M Marco Ester E Claessens Marie M Gautier Jennifer J Annweiler Cédric C Lieten Siddhartha S Benoit Florence F Surquin Murielle M Sánchez-Rodríguez Dolores D

Clinical nutrition ESPEN 20230625

<h4>Objective</h4>To determine whether the Geriatric Nutritional Risk Index (GNRI) on hospital admission was associated to an increased 14-day and 12-month mortality-risk in older inpatients with COVID-19.<h4>Methods</h4>Cohort study of consecutive inpatients admitted with COVID-19 in a university hospital (20/03/2020-11/05/2021).<h4>Inclusion criteria</h4>age over 65 years and positive polymerase chain reaction test.<h4>Exclusion criteria</h4>missing data for weight, height, and/or albumin, hos ...[more]

PMID: 37739719

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Project description:Background & aimsOverweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19.MethodsWe analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression.ResultsAfter adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91).ConclusionsOur results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

Project description:BackgroundMalnutrition is a complication of chronic kidney disease (CKD). Whether malnutrition, assessed via the geriatric nutritional risk index (GNRI), is associated with the incidence and risk of CKD in older individuals remains unclear.MethodsData from the National Health and Nutrition Examination Survey and the UK Biobank database were used. Older participants over 60 years old with available data for GNRI assessment and CKD diagnosis were enrolled. Logistic regression models and Cox regression models were used to assess associations between the geriatric nutritional risk index and the risk of and mortality associated with CKD.ResultsThis study enrolled 13,162 participants from the NHANES and 66,326 participants from the UK Biobank. We identified 6,135 and 16,662 CKD patients in the NHANES and UK Biobank, respectively, with the majority being male (74% in the NHANES and 52% in the UK Biobank). The average age of CKD patients was 72.3 (SD 7.2) years in the NHANES and 64.9 (SD 2.9) years in the UK Biobank. The median follow-up times of older CKD patients were 81 months and 162 months in the NHANES and UK Biobank, respectively. According to the cross-sectional analysis, individuals with a lower GNRI had an increased likelihood of having CKD, with odds ratios of 1.38 (95% CI: 1.05-1.80, P = 0.020) in the NHANES and 2.35 (95% CI: 1.89-2.92, P < 0.001) in the UK Biobank. According to our analysis of the risk of incident CKD in the UK Biobank, a lower GNRI was associated with a greater incidence of CKD (HR: 1.11, 95% CI: 1.04-1.18; P = 0.002). According to the analysis of the risk of mortality, a lower GNRI was associated with an increased risk of death among older CKD patients (NHANES: HR: 1.69, 95% CI: 1.13-2.53, P = 0.011; UK Biobank: HR: 2.28, 95% CI: 1.94-2.69, P < 0.001).ConclusionMalnutrition assessed by the GNRI was significantly and independently associated with the incidence of CKD. Moreover, CKD patients with malnutrition also have a high risk of mortality.

Dataset Information

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort.

Objective

Methods

Inclusion criteria

Exclusion criteria

Outcome

Results

Conclusions

Publications

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort.

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