Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

Hebatullah O Mohammed; Azza M Hassan; Aya Mostafa; Mohamed S Khater; Aisha Aboelfotoh; Khaled M Abd Elaziz

doi:10.1186/s12877-024-04671-5

Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

BMC Geriatr. 2024 Jan 15;24(1):62. doi: 10.1186/s12877-024-04671-5.

Authors

Hebatullah O Mohammed¹, Azza M Hassan², Aya Mostafa², Mohamed S Khater³, Aisha Aboelfotoh², Khaled M Abd Elaziz²

Affiliations

¹ Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt. hebatullah.o.diab@med.asu.edu.eg.
² Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt.
³ Department of geriatrics and gerontology. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt.

Abstract

Background: Elderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes.

Methods: A hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted.

Results: The prevalence of high-nutritional risk was 45.5% (95% CI, 40%-51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37-17.45), HAIs (AOR: 3.18; 95% CI, 1.48-6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04-18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk.

Conclusion: GNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.

Keywords: Geriatric; Length of stay; Malnutrition; Mortality; Nutritional risk.

MeSH terms

Aged
Egypt / epidemiology
Geriatric Assessment
Hospitals
Humans
Malnutrition* / diagnosis
Malnutrition* / epidemiology
Malnutrition* / therapy
Nutrition Assessment
Nutritional Status
Pressure Ulcer*
Prospective Studies
Risk Factors