| Background:Pneumonia is the third leading cause of death worldwide.When patients with pneumonia combined with respiratory failure,circulatory failure and other organ dysfunction,can be identified as severe pneumonia.The elderly pneumonia is more likely to develop into severe pneumonia due to the decline of immune function,poor nutritional status,multiple basic diseases and the increase of drug resistance.Severe pneumonia patients progress rapidly and have a high fatality rate.Studies have shown that malnutrition is a major independent predictor of adverse outcomes in elderly hospitalized patients.Therefore,early identification and timely correction of high-risk nutritional status are crucial to improve the prognosis of elderly patients with severe community-acquired pneumonia(SCAP).In recent years,the Geriatric Nutritional Risk Index(GNRI),a comprehensive Nutritional Risk Index combining height,weight and serum albumin levels,has been reported to be associated with the prognosis of esophageal cancer,hepatocellular carcinoma,colorectal cancer and non-small cell lung cancer.However,the association between the GNRI and the prognosis of patients aged≥65 years with SCAP has not been studied.Therefore,this study aimed to evaluate the prognostic value of GNRI in elderly SCAP patients.Methods:Clinical data of 346 patients aged≥65 years with SCAP who were hospitalized in the First Affiliated Hospital of Guangxi Medical University from December 2013 to September 2019 were retrospectively analyzed.Patients who died during hospitalization or abandoned discharge due to poor prognosis were defined as having a poor prognosis,and patients who were discharged after improvement were defined as having a good prognosis.According to previous studies,GNRI was divided into 4 groups:high-risk group(GNRI<82),medium-risk group(82≤GNRI<92),low-risk group(92≤GNRI<98),and normal group(GNRI≥98).The chi-square test or t test was used to compare the differences between the groups.Univariate Logistic regression analysis was performed on the factors affecting the prognosis.All parameters with P<0.05 in univariate analysis were included in multivariate analysis.Multivariate logistic regression analysis was performed by the stepwise variable selection method,and Odds ratios(ORs)and 95%Confidence intervals(CI_S)of each parameter were calculated to identify independent risk factors affecting prognosis.The receiver operating characteristic curve(ROC)was used to compare the prognostic performance of the GNRI with Neutrophil-to-Lymphocyte Ratio(NLR),Platelet-to-Lymphocyte Ratio(PLR),Lymphocyte-to-Monocyte Ratio(LMR)and other inflammatory nutritional indicators for patients’prognosis.Based on the results of multivariate analysis,a GNRI-based nomogram was established for individualized prognostic risk assessment.Results:This study eventually enrolled 346 elderly patients with SCAP.The numbers of patients with high risk GNRI,moderate risk GNRI,low risk GNRI,and normal GNRI were 132(38.2%),115(33.2%),55(15.9%),and44(12.7%),respectively.Of these,209(60.4%)patients had a poor prognosis,including 112(53.5%),70(33.4%),17(8.1%),and 10(4.7%)patients in the GNRI high-risk,medium-risk,low-risk,and normal groups,respectively.The morbidity and mortality of the GNRI high-risk group,medium-risk group and low-risk group were significantly higher than those of the normal group.In the correlation analysis,we found that the gender(p=0.006),heart failure(p=0.041),cancer(p=0.031),mean arterial pressure(MAP)(p<0.001),systolic blood pressure(p=0.002),heart rate(p=0.006),white blood cells(p<0.001),hemoglobin(p=0.008),platelet(p=0.001),neutrophil(p<0.001),albumin(p<0.001),BUN(p<0.001),serum creatinine(p=0.034),GNRI(p<0.001),NLR(p=0.002),LMR(p=0.019)was significantly different between the good prognostic group and the poor prognostic group.In the univariate analysis,we found that gender(p=0.006),heart failure(p=0.042),cancer(p=0.037),MAP(p<0.001),systolic blood pressure(p=0.002),heart rate(p=0.007),temperature(p=0.024),hemoglobin(p=0.008),white blood cell count(p=0.002),platelet count(p=0.001),neutrophil count(p<0.001),BUN(p=0.001),GNRI(p<0.001),and NLR(p=0.007)were all associated with SCAP prognosis.In the multivariate analysis,only gender,MAP,neutrophil counts,and GNRI were independently correlated with the prognosis of elderly SCAP patients.After adjusting for sex,heart failure,malignancy,MAP,systolic blood pressure,heart rate,temperature,hemoglobin,white blood cell count,neutrophil count,platelet count,BUN,and NLR,either low GNRI as a continuous variable or abnormal GNRI as a binary variable were associated with prognosis(trend P<0.001).In addition,compared with the highest quartile Q4(93.78-118.04),quartile Q1(42.97-76.72),quartile Q2(76.81-85.20),and quartile Q3(85.32-93.77)were all positively correlated with poor prognosis(trend P<0.001).In the comparison of the characteristics of each GNRI group patients,we found that BMI,combined diabetes,combined hypertension,MAP,systolic blood pressure,heart rate,hemoglobin,neutrophil count,lymphocyte count,monocyte count,albumin and NLR were all statistically different(p<0.05).In addition,BMI,MAP,systolic blood pressure,hemoglobin,monocyte count and albumin in the GNRI high-risk group and the GNRI medium-risk group were lower than those in the GNRI normal group,while heart rate,neutrophil count and NLR were higher than those in the GNRI normal group.There were no significant differences in BMI,MAP,systolic blood pressure,hemoglobin,monocyte count,albumin,heart rate,neutrophil count,and NLR between the low-risk GNRI group and the normal GNRI group.GNRI(0.800,95%CI:0.7533-0.847,p<0.001)had a significant predictive prognostic efficacy on the ROC curve compared with NLR(0.612,95%CI:0.552-0.672,p<0.001),PLR(0.542,95%CI:0.481-0.603,p=0.187),and LMR(0.557,95%CI:0.496-0.618,p=0.076).The GNRI-based nomogram we constructed had excellent prediction capabilities.Conclusion:GNRI is a simple and effective prognostic indicator for elderly patients with SCAP.GNRI decreasing in elderly SCAP patients reflects nutritional risks leading to poor prognosis.Elderly SCAP patients with low GNRI are more prone to poor prognosis,and low GNRI is an independent risk factor affecting the prognosis in elderly SCAP patients.GNRI was more effective than NLR,PLR and LMR in predicting the prognosis of elderly patients with SCAP.The GNRI-based nomogram we constructed has good prediction accuracy and prediction efficiency,which can help elderly SCAP patients to provide individualized prognosis prediction to a certain extent. |
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