PDF herunterladen
Horm Metab Res 2022; 54(11): 736-746
DOI: 10.1055/a-1886-4276
Original Article: Endocrine Care

Geriatric Nutritional Risk Index and the Prognosis of Patients with Stroke: A Meta-Analysis

Jun Hu
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
,
Ting Chen
2   Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
,
Ziyue Wang
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
,
Xuhui Chen
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
,
Kaihua Lin
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
,
Guogao Zhang
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
,
Jun Wu
1   Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Malnutrition evidenced by low geriatric nutritional risk index (GNRI) has been suggested as a potential predictor of poor prognosis of patients with various clinical conditions. We performed a meta-analysis to systematically assess the association between GNRI and the prognosis of patients after stroke. Cohort studies were identified by search of PubMed, Embase, Cochrane’s Library and Web of Science databases from inception to March 25, 2022, according to the aim of the meta-analysis. A random-effect model incorporating the potential between-study heterogeneity was used to pool the results. Eight cohort studies with 13573 patients with stroke contributed to the meta-analysis. Pooled results showed that malnutrition as evidenced by low GNRI was independently associated with a higher risk of poor functional outcome [risk ratio (RR): 1.54, 95% confidence interval (CI): 1.19 to 1.98, p<0.001; I2=69%] and an increased incidence of all-cause mortality (RR: 1.82, 95% CI: 1.35 to 2.47, p<0.001; I2=74%). Sensitivity analyses showed consistent results in patients with ischemic stroke, and in prospective cohort studies. Subgroup analyses showed that the associations were not significant for patients with GNRI-defined mild malnutrition (p=0.18 and 0.20 for functional and mortality outcomes, respectively), but significant for patients with moderate-severe malnutrition (both p<0.001). Difference in follow-up durations did not significantly affect the associations (p for subgroup difference=0.75 and 0.70, respectively). In conclusion, a low GNRI is associated with poor functional and survival outcomes in patients after stroke.

Key words

geriatric nutritional risk index - malnutrition - stroke - mortality - meta-analysis


Publikationsverlauf

Eingereicht: 30. Mai 2022

Angenommen nach Revision: 19. Juni 2022

Artikel online veröffentlicht:
07. September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tsao CW, Aday AW, Almarzooq ZI. et al. Heart disease and stroke statistics-2022 update: a report from the American heart association. Circulation 2022; 145: e153-e639
    PubMedGoogle Scholar
  • 2 Wang YJ, Li ZX, Gu HQ. et al. China stroke statistics: an update on the 2019 report from the national center for healthcare quality management in neurological diseases, China national clinical research center for neurological diseases, the Chinese stroke association, national center for chronic and non-communicable disease control and prevention, Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations. Stroke Vasc Neurol 2020; 5: 211-239
    CrossrefPubMedGoogle Scholar
  • 3 Kleindorfer DO, Towfighi A, Chaturvedi S. et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association/American stroke association. Stroke 2021; 52: e364-e467
    CrossrefPubMedGoogle Scholar
  • 4 Montano A, Hanley DF, Hemphill JC. Hemorrhagic stroke. Handb Clin Neurol 2021; 176: 229-248
    CrossrefPubMedGoogle Scholar
  • 5 Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA 2018; 319: 820-821
    CrossrefPubMedGoogle Scholar
  • 6 Sabbouh T, Torbey MT. Malnutrition in stroke patients: risk factors, assessment, and management. Neurocrit Care 2018; 29: 374-384
    CrossrefPubMedGoogle Scholar
  • 7 Lieber AC, Hong E, Putrino D. et al. Nutrition, energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: a review of the literature. Brain Sci 2018; 8: 218
    CrossrefPubMedGoogle Scholar
  • 8 Chen N, Li Y, Fang J. et al. Risk factors for malnutrition in stroke patients: a meta-analysis. Clin Nutr 2019; 38: 127-135
    CrossrefPubMedGoogle Scholar
  • 9 Bouillanne O, Morineau G, Dupont C. et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777-783
    CrossrefPubMedGoogle Scholar
  • 10 Hao X, Li D, Zhang N. Geriatric nutritional risk index as a predictor for mortality: a meta-analysis of observational studies. Nutr Res 2019; 71: 8-20
    CrossrefPubMedGoogle Scholar
  • 11 Hino H, Saito T, Matsui H. et al. Utility of geriatric nutritional risk index in patients with lung cancer undergoing surgery. Eur J Cardiothorac Surg 2020; 58: 775-782
    CrossrefPubMedGoogle Scholar
  • 12 Matsukuma Y, Tanaka S, Taniguchi M. et al. Association of geriatric nutritional risk index with infection-related mortality in patients undergoing hemodialysis: the Q-cohort study. Clin Nutr 2019; 38: 279-287
    CrossrefPubMedGoogle Scholar
  • 13 Norman K, Hass U, Pirlich M. Malnutrition in older adults-recent advances and remaining challenges. Nutrients 2021; 13: 2764
    CrossrefPubMedGoogle Scholar
  • 14 Li H, Cen K, Sun W. et al. Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis. Aging Clin Exp Res 2021; 33: 1477-1486
    CrossrefPubMedGoogle Scholar
  • 15 Shi X, Shen Y, Yang J. et al. The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: a retrospective cohort study. Heart Lung 2021; 50: 898-905
    CrossrefPubMedGoogle Scholar
  • 16 Lidoriki I, Schizas D, Frountzas M. et al. GNRI as a prognostic factor for outcomes in cancer patients: a systematic review of the literature. Nutr Cancer 2021; 73: 391-403
    CrossrefPubMedGoogle Scholar
  • 17 Jia Z, El Moheb M, Nordestgaard A. et al. The geriatric nutritional risk index is a powerful predictor of adverse outcome in the elderly emergency surgery patient. J Trauma Acute Care Surg 2020; 89: 397-404
    CrossrefPubMedGoogle Scholar
  • 18 Maruyama K, Nakagawa N, Koyama S. et al. Malnutrition increases the incidence of death, cardiovascular events, and infections in patients with stroke after rehabilitation. J Stroke Cerebrovasc Dis 2018; 27: 716-723
    CrossrefPubMedGoogle Scholar
  • 19 Kang MK, Kim TJ, Kim Y. et al. Geriatric nutritional risk index predicts poor outcomes in patients with acute ischemic stroke – automated undernutrition screen tool. PLoS One 2020; 15: e0228738
    CrossrefPubMedGoogle Scholar
  • 20 Akimoto T, Hara M, Morita A. et al. Relationship between nutritional scales and prognosis in elderly patients after acuteischemic stroke: comparison of controlling nutritional status score and geriatric nutritional risk index. Ann Nutr Metab 2021; 77: 116-123
    CrossrefPubMedGoogle Scholar
  • 21 Nozoe M, Kubo H, Kanai M. et al. Relationships between pre-stroke SARC-F scores, disability, and risk of malnutrition and functional outcomes after stroke – a prospective cohort study. Nutrients 2021; 13: 3586
    CrossrefPubMedGoogle Scholar
  • 22 Yuan K, Zhu S, Wang H. et al. Association between malnutrition and long-term mortality in older adults with ischemic stroke. Clin Nutr 2021; 40: 2535-2542
    CrossrefPubMedGoogle Scholar
  • 23 Zhang M, Ye S, Huang X. et al. Comparing the prognostic significance of nutritional screening tools and ESPEN-DCM on 3-month and 12-month outcomes in stroke patients. Clin Nutr 2021; 40: 3346-3353
    CrossrefPubMedGoogle Scholar
  • 24 Tang H, Gong F, Guo H. et al. Malnutrition and risk of mortality in ischemic stroke patients treated with intravenous thrombolysis. Front Aging Neurosci 2022; 14: 834973
    CrossrefPubMedGoogle Scholar
  • 25 Zhang G, Pan Y, Zhang R. et al. Prevalence and prognostic significance of malnutrition risk in patients with acute ischemic stroke: results from the third China national stroke registry. Stroke 2022; 53: 111-119
    CrossrefPubMedGoogle Scholar
  • 26 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160
    CrossrefPubMedGoogle Scholar
  • 27 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    Google Scholar
  • 28 Higgins J, Thomas J, Chandler J. et al. Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration. 2021 www.training.cochrane.org/handbook
    PubMedGoogle Scholar
  • 29 Tang G, Cao Z, Luo Y. et al. Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis. J Neurol 2022; DOI: 10.1007/s00415-022-11046-6.. Online ahead of print
    CrossrefPubMedGoogle Scholar
  • 30 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMed
  • 31 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    CrossrefPubMedGoogle Scholar
  • 32 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 33 Parkkinen J, Ojala P, Niiranen J. et al. Molecular mechanisms underlying neuroprotective effects of albumin after ischemic stroke. Stroke 2007; 38: 255 author reply 256
    CrossrefPubMedGoogle Scholar
  • 34 Yao X, Miao W, Li M. et al. Protective effect of albumin on VEGF and brain edema in acute ischemia in rats. Neurosci Lett 2010; 472: 179-183
    CrossrefPubMedGoogle Scholar
  • 35 Prajapati KD, Sharma SS, Roy N. Current perspectives on potential role of albumin in neuroprotection. Rev Neurosci 2011; 22: 355-363
    CrossrefPubMedGoogle Scholar
  • 36 Zhang P, Yan XL, Qu Y. et al. Association between abnormal body weight and stroke outcome: a meta-analysis and systematic review. Eur J Neurol 2021; 28: 2552-2564
    CrossrefPubMedGoogle Scholar
  • 37 Forlivesi S, Cappellari M, Bonetti B. Obesity paradox and stroke: a narrative review. Eat Weight Disord 2021; 26: 417-423
    CrossrefPubMedGoogle Scholar
  • 38 Lee M, Lim JS, Kim Y. et al. Association between geriatric nutritional risk index and post-stroke cognitive outcomes. Nutrients 2021; 13: 1776
    CrossrefPubMedGoogle Scholar
  • 39 Kalantar-Zadeh K, Kopple JD, Block G. et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001; 38: 1251-1263
    CrossrefPubMedGoogle Scholar
  • 40 Chen W, Fong JW, Lind CR. et al. P-POSSUM scoring system for mortality prediction in general neurosurgery. J Clin Neurosci 2010; 17: 567-570
    CrossrefPubMedGoogle Scholar
  • 41 Steiber AL, Kalantar-Zadeh K, Secker D. et al. Subjective global assessment in chronic kidney disease: a review. J Ren Nutr 2004; 14: 191-200
    CrossrefPubMedGoogle Scholar
  • 42 Duran Alert P, Mila Villarroel R, Formiga F. et al. Assessing risk screening methods of malnutrition in geriatric patients: mini nutritional assessment (MNA) versus geriatric nutritional risk index (GNRI). Nutr Hosp 2012; 27: 590-598
    PubMedGoogle Scholar
  • 43 Leandro-Merhi VA, de Aquino JLB, Reis LO. Predictors of nutritional risk according to NRS-2002 and calf circumference in hospitalized older adults with neoplasms. Nutr Cancer 2017; 69: 1219-1226
    CrossrefPubMedGoogle Scholar