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Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Author

Listed:
  • Wei-Ti Su

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan
    These authors contributed equally to this work.)

  • Shao-Chun Wu

    (Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan
    These authors contributed equally to this work.)

  • Chun-Ying Huang

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

  • Sheng-En Chou

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

  • Ching-Hua Tsai

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

  • Chi Li

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

  • Shiun-Yuan Hsu

    (Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

  • Ching-Hua Hsieh

    (Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 803, Taiwan)

Abstract

Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI < 82; group 1, n = 127), moderate-risk group (GNRI 82–92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI > 98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.

Suggested Citation

  • Wei-Ti Su & Shao-Chun Wu & Chun-Ying Huang & Sheng-En Chou & Ching-Hua Tsai & Chi Li & Shiun-Yuan Hsu & Ching-Hua Hsieh, 2020. "Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study ," IJERPH, MDPI, vol. 17(23), pages 1-9, November.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:23:p:8920-:d:454112
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    References listed on IDEAS

    as
    1. Meng-Wei Chang & Hang-Tsung Liu & Chun-Ying Huang & Peng-Chen Chien & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2018. "Location of Femoral Fractures in Patients with Different Weight Classes in Fall and Motorcycle Accidents: A Retrospective Cross-Sectional Analysis," IJERPH, MDPI, vol. 15(6), pages 1-9, May.
    2. Cheng-Shyuan Rau & Shao-Chun Wu & Pao-Jen Kuo & Yi-Chun Chen & Peng-Chen Chien & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2017. "Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score," IJERPH, MDPI, vol. 14(11), pages 1-15, November.
    3. Chien-En Tang & Hang-Tsung Liu & Pao-Jen Kuo & Yi-Chun Chen & Shiun-Yuan Hsu & Chih-Che Lin & Ching-Hua Hsieh, 2018. "Impact of Sexual Dimorphism on Trauma Patterns and Clinical Outcomes of Patients with a High-Risk Score of the Osteoporosis Self-Assessment Tool for Asians: A Propensity Score-Matched Analysis," IJERPH, MDPI, vol. 15(3), pages 1-12, February.
    4. Cheng-Shyuan Rau & Shao-Chun Wu & Yi-Chun Chen & Peng-Chen Chien & Hsiao-Yun Hsieh & Pao-Jen Kuo & Ching-Hua Hsieh, 2017. "Mortality Rate Associated with Admission Hyperglycemia in Traumatic Femoral Fracture Patients Is Greater Than Non-Diabetic Normoglycemic Patients but Not Diabetic Normoglycemic Patients," IJERPH, MDPI, vol. 15(1), pages 1-10, December.
    5. Chien-Chang Chen & Cheng-Shyuan Rau & Shao-Chun Wu & Pao-Jen Kuo & Yi-Chun Chen & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2016. "Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures," IJERPH, MDPI, vol. 13(10), pages 1-15, October.
    6. Shiun-Yuan Hsu & Shao-Chun Wu & Cheng-Shyuan Rau & Ting-Min Hsieh & Hang-Tsung Liu & Chun-Ying Huang & Sheng-En Chou & Wei-Ti Su & Ching-Hua Hsieh, 2019. "Impact of Adapting the Abbreviated Injury Scale (AIS)-2005 from AIS-1998 on Injury Severity Scores and Clinical Outcome," IJERPH, MDPI, vol. 16(24), pages 1-10, December.
    7. Cheng-Shyuan Rau & Shao-Chun Wu & Pao-Jen Kuo & Yi-Chun Chen & Peng-Chen Chien & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2017. "Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trau," IJERPH, MDPI, vol. 14(12), pages 1-12, December.
    8. Lisa A. Barker & Belinda S. Gout & Timothy C. Crowe, 2011. "Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System," IJERPH, MDPI, vol. 8(2), pages 1-14, February.
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