The prognostic effects of the geriatric nutritional risk index on elderly acute kidney injury patients in intensive care units

Dan Liao; Yonghua Deng; Xinchun Li; Ju Huang; Jiayue Li; Ming Pu; Fenglian Zhang; Lijun Wang

doi:10.3389/fmed.2023.1165428

The prognostic effects of the geriatric nutritional risk index on elderly acute kidney injury patients in intensive care units

Front Med (Lausanne). 2023 May 11:10:1165428. doi: 10.3389/fmed.2023.1165428. eCollection 2023.

Authors

Dan Liao^#¹, Yonghua Deng^#², Xinchun Li³, Ju Huang⁴, Jiayue Li⁵, Ming Pu⁵, Fenglian Zhang¹, Lijun Wang¹

Affiliations

¹ Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
² Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China.
³ North Sichuan Medical College, Nanchong, China.
⁴ Department of Nephrology, Mianyang People's Hospital, Mianyang, China.
⁵ Chengdu Medical College, Chengdu, China.

^# Contributed equally.

Abstract

Introduction: The geriatric nutritional risk index (GNRI), a nutritional screening tool specifically for the aging population, has been proven to be associated with worse outcomes in chronic kidney disease patients, especially in the hemodialysis population. However, the predictive validity of GNRI in critically ill elderly patients with acute kidney injury (AKI) is yet to be determined. This analysis sought to examine the prognostic effects of GNRI on elderly AKI patients in intensive care units (ICUs).

Methods: We collected elderly AKI patient-relevant data from the Medical Information Mart for Intensive Care III database. AKI was diagnosed and staged according to the "Kidney Disease Improving Global Outcomes" criteria. In the study, 1-year mortality was considered the primary outcome, whereas in-hospital, ICU, 28-day and 90-day mortality, and prolonged length of stay in ICU and hospital were selected as the secondary outcomes.

Results: In all, 3,501 elderly patients with AKI were selected for this study, with a 1-year mortality rate of 36.4%. We classified the study population into low (≤98) and high (>98) GNRI groups based on the best cutoff value. The incidence of endpoints was remarkably lower in patients with elevated GNRI (p < 0.001). When stratified by the AKI stage, patients with high GNRI at AKI stages 1, 2, and 3 had markedly lower 1-year mortality than those with low GNRI (all p < 0.05). The multivariable regression analysis identified the independent prognostic ability of GNRI on the research outcomes (all p < 0.05). Restricted cubic spline exhibited a linear correlation between GNRI and 1-year death (p for non-linearity = 0.434). The prognostic implication of GNRI on 1-year mortality was still significant in patients with the most subgroups.

Conclusion: In critically ill elderly patients with AKI, elevated GNRI upon admission was strongly correlated with a lower risk of unfavorable outcomes.

Keywords: acute kidney injury; elderly; geriatric nutritional risk index; intensive care unit; prognosis.