Abstract:Objective To explore the value of the geriatric nutritional risk index (GNRI) in evaluating the prognosis of patients with hospital-acquired pneumonia (HAP) in geriatric patients, and a histogram model was established to predict the prognosis of elderly HAP patients. Methods A total of 411 patients in the Emergency Center of the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to January 2020 were included in this study. All patients were divided into modeling group (308 cases) and validation group (103 cases) in a 3∶1 ratio by simple randomization method. Multivariate logistic regression analysis was used to analyze the independent risk factors for poor prognosis in elderly HAP patients. R software was used to construct a histogram model to predict the risk of poor prognosis in elderly HAP patients, and the model was verified. Results Univariate regression analysis showed that age, gender, systolic blood pressure, diastolic blood pressure, heart rhythm, congestive heart failure, chronic kidney disease, fasting blood glucose, low density lipoprotein cholesterol, GNRI scores were associated with poor prognosis in elderly HAP patients (P < 0.05), multivariate regression analysis showed that age, gender, congestive heart failure, and GNRI score were independent risk factors for poor prognosis in elderly HAP patients (P < 0.05). The model was validated internally and externally, and the AUC value in the modeling group was 0.854 (95%CI: 0.827-0.881), AUC value in the validation group was 0.841 (95%CI: 0.803-0.879), Hosmer-Lemeshow test results indicate that the prediction model has good stability: modeling queue (P = 0.739) and validation queue (P = 0.469). Conclusion The prediction model established in this study can accurately predict the individual risk of poor prognosis in elderly HAP patients, and has a high potential clinical application value.
[1] Lanks CW,Musani AI,Hsia DW. Community-acquired Pneumonia and Hospital-acquired Pneumonia [J]. Med Clin North Am,2019,103(3):487-501.
[2] 肖婕,黎莉,邓智全,等.老年慢性心衰住院患者医院获得性肺炎的病原菌及其影响因素[J].中华医院感染学杂志,2020,30(1):72-76.
[3] Roquilly A,Torres A,Villadangos JA,et al. Pathophysiological role of respiratory dysbiosis in hospital-acquired pneumonia [J]. Lancet Respir Med,2019,7(8):710-720.
[4] Luyt CE,Hékimian G,Koulenti D,et al. Microbial cause of ICU-acquired pneumonia:hospital-acquired pneumonia versus ventilator-associated pneumonia [J]. Curr Opin Crit Care,2018,24(5):332-338.
[5] Ranzani OT,De Pascale G,Park M. Diagnosis of nonventilated hospital-acquired pneumonia:how much do we know? [J]. Curr Opin Crit Care,2018,24(5):339-346.
[6] Makhnevich A,Feldhamer KH,Kast CL,et al. Aspiration Pneumonia in Older Adults [J]. J Hosp Med,2019,14(7):429-435.
[7] Bouillanne O,Morineau G,Dupont C,et al. Geriatric Nutritional Risk Index:a new index for evaluating at-risk elderly medical patients [J]. Am J Clin Nutr,2005,82(4):777-783.
[8] 唐梦君,丁叔波,胡望远.老年营养风险指数在行放射治疗高龄食管癌患者预后评估中的价值[J].中国医药导报,2020,17(6):62-65.
[9] Hanada M,Yamauchi K,Miyazaki S,et al. Geriatric Nutritional Risk Index,a predictive assessment tool,for postoperative complications after abdominal surgery:A prospective multicenter cohort study [J]. Geriatr Gerontol Int,2019,19(9):924-929.
[10] Veronese N,Cereda E,Solmi M,et al. Inverse relationship between body mass index and mortality in older nursing home residents:a meta-analysis of 19,538 elderly subjects [J]. Obes Rev,2015,16(11):1001-1015.
[11] Nakamura T,Matsumoto M,Haraguchi Y,et al. Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged ? 80 years with heart failure [J]. Eur J Cardiovasc Nurs,2020,19(2):172-177.
[12] Shi Y,Huang Y,Zhang TT,et al. Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults (2018 Edition) [J]. J Thorac Dis,2019,11(6):2581-2616.
[13] Martin-Loeches I,Rodriguez AH,Torres A. New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia:USA vs. Europe [J]. Curr Opin Crit Care,2018,24(5):347-352.
[14] Zheng W,Zhu W,Yu S,et al. Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma [J]. BMC Cancer,2020,20(1):1066.
[15] Klompas M. Prevention of Intensive Care Unit-Acquired Pneumonia [J]. Semin Respir Crit Care Med,2019,40(4):548-557.
[16] Cederholm T,Jensen GL,Correia M,et al. GLIM criteria for the diagnosis of malnutrition-A consensus report from the global clinical nutrition community [J]. Clin Nutr,2019,38(1):1-9.
[17] Xiong J,Wang M,Zhang Y,et al. Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients:A Meta-Analysis of Cohort Studies [J]. Kidney Blood Press Res,2018,43(6):1878-1889.
[18] Maruyama K,Nakagawa N,Koyama S,et al. Malnutrition Increases the Incidence of Death,Cardiovascular Events,and Infections in Patients with Stroke after Rehabilita-tion [J]. J Stroke Cerebrovasc Dis,2018,27(3):716-723.
[19] 苗晓慧,尚晓滨,张洪典,等.老年营养风险指数对食管鳞癌患者根治性切除术后生存的影响[J].中国肿瘤临床,2019,46(6):293-298.
[20] Inoue T,Misu S,Tanaka T,et al. Acute phase nutritional screening tool associated with functional outcomes of hip fracture patients:A longitudinal study to compare MNA-SF,MUST,NRS-2002 and GNRI [J]. Clin Nutr,2019,38(1):220-226.
[21] Lee GW,Go SI,Kim DW,et al. Geriatric Nutritional Risk Index as a prognostic marker in patients with extensive-stage disease small cell lung cancer:Results from a randomized controlled trial [J]. Thorac Cancer,2020,11(1):62-71.
[22] Yamada S,Yamamoto S,Fukuma S,et al. Geriatric Nutritional Risk Index (GNRI) and Creatinine Index Equally Predict the Risk of Mortality in Hemodialysis Patients:J-DOPPS [J]. Sci Rep,2020,10(1):5756.
[23] Mastronuzzi T,Grattagliano I. Nutrition as a Health Determinant in Elderly Patients [J]. Curr Med Chem,2019, 26(19):3652-3661.
[24] Lee CM,Woodward M,Batty GD,et al. Association of anthropometry and weight change with risk of dementia and its major subtypes:A meta-analysis consisting 2.8 million adults with 57 294 cases of dementia [J]. Obes Rev,2020,21(4):e12989.
[25] 赵霞,王力红,魏楠,等.老年患者医院获得性肺炎风险评估模型的构建[J].中国感染与化疗杂志,2020,20(3):271-276.