老年营养风险指数对脑卒中后神经功能预后的效能

doi:10.3969/j.issn.1006-9771.2023.11.013

Abstract

Abstract:

Objective To evaluate the efficacy of Geriatric Nutritional Risk Index (GNRI) on admission on predicting neurological outcomes for stroke patients at the convalescence stage (three months after stroke).

Methods A total of 277 inpatients with ischemic stroke in Wenzhou TCM Hospital of Zhejiang Chinese Medical University from November, 2022 to January, 2023 were divided into good outcome group (n = 195) and poor outcome group (n = 82) according to the score of modified Rankin Scale (mRS) three months after stroke. Their clinical data and GNRI were compared.

Results Compared with the good outcome group, the poor outcome group showed a lower level of GNRI (t = -9.569, P < 0.001), more proportion of patients with high nutritional risk (χ² = 68.861, P < 0.001). More cases with poor outcome were found with higher nutritional risk (Z = 65.406, P< 0.001). After covariate adjustment, higher level of GNRI was an independent protective factor for poor outcome three months after stroke (OR = 0.895, 95%CI 0.864 to 0.927, P < 0.05), and the OR increased with the nutritional risk grade of GNRI (P < 0.05). The area under the curve (AUC) of GNRI, score of NIHSS, and BMI were 0.812 (Z = 11.576, P < 0.001), 0.759 (Z = 8.328, P < 0.001), and 0.594 (Z = 2.716, P = 0.007), respectively; while the combination of GNRI and NIHSS was more effective (AUC = 0.875, Z = 17.389, P < 0.001). The sensitivities of GNRI, NIHSS and the combination of the two in predicting neurological function were 65.85%, 76.83% and 79.21%, respectively, and the specificities were 81.54%, 60.51% and 82.95%, respectively.

Conclusion GNRI on admission is associated with neurological function three months after stroke. GNRI can be used alone or in combination with NIHSS score to predict neurological outcome in the rehabilitation period, which is a useful complement to traditional predictors.

Key words: stroke, elderly, nutrition, neurological function, outcome

CLC Number:

R743.3

ZHU Lielie, XIA Jianning, PU Xinyu, SHAO Xiangzhi, ZHANG Jiacheng, WU Dengchong. Predictive efficacy of Geriatric Nutritional Risk Index on neurological outcome after stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1346-1352.

Figures/Tables 5

References 36

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项目	预后良好组(n = 195)	预后不良组(n = 82)	t/χ²/Z值	P值
年龄/岁	68.5(62.4,74.1)	72.4(62.6,77.9)	-1.600	0.110
性别(男/女)/n	117/78	27/55	16.951	< 0.001
家庭年收入超过5万元/n	161	61	2.424	0.120
婚姻状态(离异或寡居)/n	55	30	1.906	0.167
BMI/(kg·m^-2)	24.45±4.16	23.01±2.36	-3.649	< 0.001
既往吸烟/n	63	21	1.226	0.268
既往饮酒/n	68	36	2.008	0.157
并发症/n
高血压病	147	69	2.581	0.108
糖尿病	141	64	0.989	0.320
高脂血症	130	57	0.213	0.644
其他	41	20	0.381	0.537
梗死类型/n
TACI	46	13	2.444	0.295
PACI	82	41
POCI	67	28
接受溶栓治疗/n(%)	89	29	2.492	0.114
NIHSS评分	11.01±2.09	13.56±2.69	7.680	< 0.001
GNRI	101.54±10.79	88.39±9.54	-9.569	< 0.001
GNRI分级/n
Q1	8	30	68.861	< 0.001
Q2	27	21
Q3	44	15
Q4	116	16
mRS评分	2(1, 2)	4(3, 5)	-13.749	< 0.001

指标	模型1		模型2		模型3
指标	OR (95%CI)	P值	OR (95%CI)	P值	OR (95%CI)	P值
GNRI	0.889(0.862~0.918)	< 0.001	0.889(0.860~0.918)	< 0.001	0.895(0.864~0.927)^a	< 0.001
NIHSS	1.590(1.387~1.823)	< 0.001	1.571(1.366~1.808)	< 0.001	1.554(1.318~1.832)^b	< 0.001
BMI	0.887(0.816~0.963)	0.004	0.894(0.820~0.974)	0.010	0.899(0.799~1.011)^c	0.077

GNRI等级	n	模型1		模型2
GNRI等级	n	OR值(95%CI)	P值	OR值(95%CI)	P值
Q1	38	27.187(10.632~69.519)	< 0.001	28.150(10.651~74.398)	< 0.001
Q2	48	5.639(2.602~12.222)	< 0.001	5.737(2.579~12.759)	< 0.001
Q3	59	2.472(1.127~5.420)	0.024	2.603(1.162~5.834)	0.020
Q4	132	1.0	-	1.0	-
趋势性检验P值		<0.001		<0.001

指标	AUC(95%CI)	Z值	P值	Youden指数	最佳截断值	敏感性/%	特异性/%
GNRI	0.812(0.761~0.856)	11.576	< 0.001	0.4739	92.69	65.85	81.54
NIHSS	0.759(0.704~0.808)	8.328	< 0.001	0.3734	11.00	76.83	60.51
BMI	0.594(0.533~0.652)	2.716	0.007	0.2189	23.81	73.17	48.72
GNRI联合NIHSS	0.875(0.830~0.912)	17.389	< 0.001	0.5722	0.277	79.21	82.95

Predictive efficacy of Geriatric Nutritional Risk Index on neurological outcome after stroke

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