Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients
Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients
复制标题
DOI：
10.1016/j.clnu.2016.04.010
复制
发表时间：
2016-12-01
影响因子：
6.3
通讯作者：
Efrati, Shai
中科院分区：
文献类型：
--
作者：
Beberashvili, Ilia;Azar, Ada;Efrati, Shai
背景和目标：老年营养风险指数（GNRI）已被报道为维持性血液透析（MHD）患者预后的有用预测因子，表明GNRI小于90是营养状况较差和死亡率显著增加的标志。我们测试了GNRI作为一个整体是否与营养和炎症、肌肉功能、健康相关生活质量（QoL）的临床和实验室替代物更强相关，并预测该人群的全因和心血管（CV）发病率和死亡率优于其单个组分（白蛋白和体重与理想体重比）。中位随访时间为30个月的前瞻性观察性研究（四分位距- 19-41个月）对352名MHD门诊患者（38.0%女性）进行了研究，平均年龄为67.4 ± 13.2岁。测量全因和心血管住院和死亡率、GNRI、握力（HGS）、身体成分参数（人体测量学和生物阻抗）和简明生活质量量表（SF-36）评分。进行多元线性回归分析，以获得调整后的相关性。生成受试者工作特征（ROC）曲线，并应用多变量考克斯比例风险模型分别确定GNRI及其组分的预测值。GNRI与总分呈正相关（r = 0.15，P < 0.05）、躯体健康维度（r = 0.14，P < 0.05）、一般健康（r = 0.18，P < 0.01）等量表。男性患者GNRI与HGS的显著相关性经不起多变量调整。基线GNRI水平每增加一个单位，调整混杂因素后的首次住院风险比（HR）为0.98（95%置信区间（CI），0.97 - 0.99），首次CV事件HR为0.98（95% CI，0.97 - 0.99）;全因死亡HR为0.97（95% CI，0.96 - 0.99），CV死亡HR为0.97（95% CI，0.95-0.99）。白蛋白与生活质量和临床结果具有较高的强度和幅度比GNRI.Conclusions：尽管显着的关系与临床结果和生活质量，GNRI是不是更好，甚至比白蛋白的性能略差。这引起了人们对GNRI作为MHD人群预后工具的临床效用的怀疑。(C)2016爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background & aims: The geriatric nutritional risk index (GNRI) has been reported as a useful predictor of prognosis in maintenance hemodialysis (MHD) patients, demonstrating GNRI less than 90 as a marker of a poorer nutritional status and significantly increased mortality. We tested whether GNRI as a whole associated stronger with clinical and laboratory surrogates of nutrition and inflammation, muscle function, health-related quality of life (QoL), and predicts all-cause and cardiovascular (CV) morbidity and mortality in this population better than its individual components (albumin and body weight to ideal body weight ratio).Methods: A prospective observational study with a median follow-up of 30 months (interquartile range - 19-41 months) was performed on 352 MHD outpatients (38.0% women) with a mean age of 67.4 +/- 13.2 years. All-cause and cardiovascular hospitalization and mortality, GNRI, handgrip strength (HGS), body composition parameters (anthropometry and bioimpedance) and short form 36 (SF-36) quality-of-life scores were measured. Multivariate linear regression analyses were performed to obtain adjusted correlations. Receiver operating characteristic (ROC) curves were generated and multivariate Cox proportional hazards models were applied to identify the predictive value of GNRI and its components separately.Results: GNRI positively correlated with total score (r = 0.15, P < 0.05), the physical health dimension (r = 0.14, P < 0.05), the general health (r = 0.18, P < 0.01) and some other scales of the SF-36. A significant correlation of GNRI with HGS in male patients didn't stand up to multivariable adjustments. For each one unit increase in baseline GNRI levels, the first hospitalization hazard ratio (HR) after adjustments for confounders was 0.98 (95% confidence interval (CI), 0.97 to 0.99) and the first CV event HR was 0.98 (95% CI, 0.97 to 0.99); all-cause death HR was 0.97 (95% CI, 0.96 to 0.99) and CV death HR was 0.97 (95% CI, 0.95-0.99). Albumin was related to QoL and clinical outcomes with higher strength and magnitude than GNRI.Conclusions: Despite the significant relationship with clinical outcomes and QOL, GNRI is not better and is even slightly worse than albumin's performance. This raises doubts as to the clinical utility of GNRI as a prognostic tool in the MHD population. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.