Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

Zhiqiang Chen; Quanshui Hao; Rao Sun; Yanjing Zhang; Hui Fu; Shile Liu; Chenglei Luo; Hanwen Chen; Yiwen Zhang

doi:10.1111/cns.14343

Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

CNS Neurosci Ther. 2024 Feb;30(2):e14343. doi: 10.1111/cns.14343. Epub 2023 Jul 5.

Authors

Zhiqiang Chen¹, Quanshui Hao², Rao Sun³, Yanjing Zhang¹, Hui Fu¹, Shile Liu¹, Chenglei Luo¹, Hanwen Chen¹, Yiwen Zhang¹

Affiliations

¹ Department of Anesthesiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
² Department of Anesthesiology, Huanggang Central Hospital of Yangtze University, Huanggang, China.
³ Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Aims: The aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD.

Methods: The data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: A total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42-2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05).

Conclusions: Our results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single-center cohort and will need to be validated in future studies involving multiple centers.

Keywords: cardiac surgery; elderly patients; geriatric nutrition risk index; postoperative delirium; risk factor.

MeSH terms

Aged
Cardiac Surgical Procedures* / adverse effects
Emergence Delirium*
Humans
Malnutrition* / diagnosis
Malnutrition* / epidemiology
Nutrition Assessment
Nutritional Status
Retrospective Studies
Risk Factors