Cerrahi Yoğun Bakım Ünitesindeki Geriatrik Ortopedik Travma Hastalarında Geriatrik Nutrisyonel Risk İndeksi ile Prognostik Nutrisyonel İndeksin Prognostik Değeri

Abstract

Amaç: Malnutrisyon, geriatrik hastalarda postoperatif morbidite ve mortalite ile ilişkilidir. Bu çalışmada, geriatrik ortopedik travmalı hastalarda geriatrik nutrisyonel risk indeksi (GNRI) ve prognostik nutrisyonel indeksin (PNI) prognostik değeri araştırılmıştır. Gereç ve Yöntemler: Haziran 2019 ile Haziran 2022 tarihleri arasında ortopedik travma cerrahisi sonrasında cerrahi yoğun bakım ünitesinde takip edilen geriatrik (≥65 yaş) hastalar retrospektif olarak değerlendirildi. Hastalar mortalite ve yaşayan grupları olarak sınıflandırıldı. GNRI, serum albümin düzeyi ile gerçek vücut ağırlığının ideal vücut ağırlığına oranına göre hesaplandı. PNI ise serum albumin düzeyi ve kan lenfosit sayısından elde edildi. Bulgular: Çalışmaya 371 hasta dahil edildi. Mortalite grubunda Amerikan Anestezistler Derneği (American Society of Anesthesiologists, ASA) IV statüsü anlamlı olarak daha yüksekti (p<0,001). Mortalite grubunda ortalama BMI, albumin, lenfosit düzeyleri ile PNI ve GNRI anlamlı şekilde daha düşüktü (sırasıyla p=0,009, p=0,008, p=0,030, p=0,001 ve p=0,003). Mortalite grubunda ortanca Glasgow koma skalası (GKS) skoru anlamlı şekilde daha düşükken, ortanca akut fizyoloji ve kronik sağlık değerlendirmesi (acute physiology and chronic health evaluation, APACHE)-II skoru ve ortanca yaralanma şiddet skoru (injury severity score, ISS) anlamlı olarak daha yüksekti (hepsi için p<0,001). Regresyon analizinde ASA IV statüsü, APACHE-II skoru ve ISS’nin mortalitenin bağımsız prediktörleri olduğu belirlendi. ROC eğrisi analizinde, eğri altında kalan alan (area under the curve, AUC), GNRI için 0,660 (%95 GA, 0,553-0,768) ve PNI için 0,654 (%95 GA, 0,566-0,743) saptandı. Sonuç: Geriatrik ortopedik travmalı hastalarda, nutrisyonel skorlardan GNRI ve PNI, hastane içi mortalitenin öngörülmesinde faydalıdır. Prognostik değerleri yüksek olmamakla birlikte benzer saptanmıştır.

Keywords

• Travma
• malnütrisyon
• geriatrik nutrisyonel risk indeks
• prognostik nutrisyonel indeks
• mortalite

Prognostic Value of Geriatric Nutritional Risk Index and Prognostic Nutritional Index in Geriatric Orthopedic Trauma Patients in the Surgical Intensive Care Unit

Abstract

Aim: Malnutrition is associated with postoperative morbidity and mortality in geriatric patients. This study investigated the prognostic value of geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) in geriatric orthopedic trauma patients. Material and Methods: Geriatric (≥65 years old) patients followed in the surgical intensive care unit after orthopedic trauma surgery between June 2019 and June 2022 were evaluated retrospectively. Patients were classified into mortality and survivor groups. GNRI was calculated according to the ratio of serum albumin level and actual body weight to ideal body weight. PNI was obtained from serum albumin level and blood lymphocyte count. Results: The study included 371 patients. American Society of Anesthesiologists (ASA) IV status was significantly higher in the mortality group (p<0.001). Mean BMI, albumin, lymphocyte levels, PNI, and GNRI were significantly lower in the mortality group (p=0.009, p=0.008, p=0.030, p=0.001, and p=0.003, respectively). While the median Glasgow coma scale (GCS) score was significantly lower, the median acute physiology and chronic health evaluation (APACHE)-II score and median injury severity score (ISS) were significantly higher in the mortality group (p<0.001 for all). Regression analysis revealed that ASA IV status, APACHE-II score, and ISS were independent predictors of mortality. In ROC curve analysis, the area under the curve (AUC) for GNRI was 0.660 (95% CI, 0.553-0.768), and the AUC for PNI was 0.654 (95% CI, 0.566-0.743). Conclusion: In geriatric orthopedic trauma patients, nutritional scores GNRI and PNI help predict in-hospital mortality. Although their prognostic values are not high, they are similar.

Keywords

• Trauma
• malnutrition
• geriatric nutritional risk index
• prognostic nutritional index
• mortality

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