Unplanned Hemodialysis Initiation and Low Geriatric Nutritional Risk Index Scores are Associated with End-Stage Renal Disease Outcomes

Background Patients with end-stage renal disease (ESRD) have low nutritional status, presenting a high mortality risk. The geriatric nutritional risk index (GNRI) is a predictive marker of malnutrition. However, it is unclear whether the association between unplanned hemodialysis (HD) and GNRI scores is related to mortality. Methods The 180 patients who underwent HD at our hospital were divided into two groups: unplanned initiation with a central venous catheter (CVC; n=73) or planned initiation with prepared vascular access (n=107). Results There were no significant differences in sex, age, malignant tumor, hypertension, and vascular disease, while there were significant differences in time from the first visit to HD initiation (0 vs. 7 times, p=0.012) and days between the first visit and HD (12 vs. 186 days, p<0.001). The CVC insertion group had significantly lower GNRI scores at initiation (85.5 vs. 98.8, p<0.001). The adjusted hazard ratios were 4.115 and 3.077 for the GNRI scores and frequency, respectively. Three-year survival was significantly lower in the CVC + low GNRI group (p<0.0001). GNRI after 1 month was significantly inferior in the CVC insertion group. Conclusions Inadequate general management due to late referral to the nephrology department is a risk factor for patients with ESRD.

The Role of Geriatric Nutritional Risk Index in Predicting Postoperative Pulmonary Complications in Elderly Lung Cancer Patients Undergoing Surgical Resection

Background The relationship between immunonutritional status (eg. Prognostic nutritional index [PNI] and Controlling Nutritional Status [COUNT] score) and risk of postoperative pulmonary complications (PPCs) after surgical resection of lung cancer had reported before. However, another immunonutritional parameter- Geriatric Nutritional Risk Index (GNRI)-had never explored. Method To address this issue, in this study we retrospectively analyzed patients’ characteristics and PPCs in a cohort of lung cancer patients who were treated by surgical resection at our center. The clinical utility of patients’ characteristics for predicting PPCs was evaluated by receiver operating characteristic curve analysis and the Youden index. Univariate and multivariate analysis were applied to find the most important factors. Result A total of 128 patients met the inclusion criteria for this study. Significant differences in sex, GNRI, FEV1%, LY% were found between the PPC and non-PPC groups (all P<0.05). The difference in pathology between the 2 groups showed borderline statistical significance (P=0.052). We determined the best cutoff value of each parameter and calculated the corresponding sensitivity and specificity, and found that GNRI, FEV1% and LY% had similar diagnostic value. Multivariate analysis reveled GNRI, sex, LY% and FEV1% were filtered to be correlated to PPCs of elderly lung cancer patients received surgery therapy. Conclusion These results indicate that preoperative immunonutritional parameters of GNRI can be used to identify elderly lung cancer patients at risk of PPCs.

The Role of Geriatric Nutritional Risk Index in Predicting Postoperative Pulmonary Complications in Elderly Lung Cancer Patients Undergoing Surgical Resection

Background: The relationship between immunonutritional status (eg. Prognostic nutritional index [PNI] and Controlling Nutritional Status [COUNT] score) and risk of postoperative pulmonary complications (PPCs) after surgical resection of lung cancer had reported before. However, another immunonutritional parameter- Geriatric Nutritional Risk Index (GNRI)-had never explored.Method: To address this issue, in this study we retrospectively analyzed patients’ characteristics and PPCs in a cohort of lung cancer patients who were treated by surgical resection at our center. The clinical utility of patients’ characteristics for predicting PPCs was evaluated by receiver operating characteristic curve analysis and the Youden index. Univariate and multivariate analysis were applied to find the most important factors.Result: A total of 128 patients met the inclusion criteria for this study. Significant differences in sex, GNRI, FEV1%, LY% were found between the PPC and non-PPC groups (all P<0.05). The difference in pathology between the 2 groups showed borderline statistical significance (P=0.052). We determined the best cutoff value of each parameter and calculated the corresponding sensitivity and specificity, and found that GNRI, FEV1% and LY% had similar diagnostic value. Multivariate analysis reveled GNRI, sex, LY% and FEV1% were filtered to be correlated to PPCs of elderly lung cancer patients received surgery therapy.Conclusion: These results indicate that preoperative immunonutritional parameters of GNRI can be used to identify elderly lung cancer patients at risk of PPCs.

Prognostic value of hemoglobin combined with Geriatric Nutritional Risk Index scores in patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma

Aims: To investigate the prognostic value of hemoglobin combined with geriatric nutritional risk index (GNRI) scores in patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Patients & methods: Patients who underwent esophagectomy and postoperative radiotherapy were included in this retrospective study. Their preoperative hemoglobin and GNRI were collected to establish hemoglobin-GNRI (H-GNRI) scores, and their association with OS was evaluated. Results: Patients with high H-GNRI scores had better prognosis than those with low scores (p < 0.001). Differentiation (p = 0.001), T classification (p = 0.010), N classification (p = 0.001) and H-GNRI score (p = 0.018) were independent prognostic factors for all patients. Conclusion: H-GNRI score is an independent prognostic factor for the survival of patients with ESCC managed by surgery and postoperative radiotherapy.

Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

Background The nutritional status can potentially affect the efficacy of cancer therapy. The Geriatric Nutritional Risk Index (GNRI), a simple index for evaluating nutritional status calculated from body weight and serum albumin levels, has been reported to be associated with the prognosis of various diseases. However, the relationships between GNRI and the efficacy of platinum-based chemotherapy in patients with non-small-cell lung cancer (NSCLC) are unknown. Methods The pretreatment levels of GNRI were retrospectively evaluated in 148 chemo-naïve patients with advanced NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 44.5% [95% confidence interval {CI} = 35.6%–53.9%] vs. 15.8% [95% CI = 7.4%–30.4%, p = 0.002), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of better ORR in multivariate logistic regression analysis and longer PFS and OS in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.

The Clinical Utility of the Geriatric Nutritional Risk Index in Predicting Postoperative Complications and Long-Term Survival in Elderly Patients with Colorectal Cancer after Curative Surgery

Research on the relationship between the geriatric nutritional risk index (GNRI) and postoperative complications/oncological outcomes in elderly colorectal cancer (CRC) patients is limited. This study investigated the prognostic value of the GNRI in aged CRC patients. We retrospectively analyzed 1206 consecutive CRC patients aged over 75 years who underwent curative-intent surgery from January 2008 to December 2015 and categorized them into high GNRI (≥98) and low GNRI (<98) groups according to a receiver operating characteristic (ROC) curve analysis. Uni- and multivariate logistic regression analysis were used to explore the association of the GNRI with postoperative complications. Kaplan–Meier survival analyses and the Cox proportional hazard model were used to explore the association between GNRI and survival. We discovered that GNRI is an independent risk factor for postoperative complications (HR: 1.774, p = 0.037). Surgical site infection, wound dehiscence and pneumonia were more common in patients with GNRI < 98. Survival analysis showed significantly worse overall survival and disease-free survival in the low GNRI group (both p < 0.001). In the multivariate analysis, GNRI < 98 was an independent risk factor for OS (HR: 1.329, p = 0.031) and DFS (HR: 1.312, p = 0.034). Thus, preoperative GNRI can be effectively used to predict postoperative complications and long-term survival in elderly CRC patients after curative surgery.

Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

Background The nutritional status can potentially affect the efficacy of cancer therapy. We evaluated the relationships between the nutritional status and the efficacy of chemotherapy in patients with non-small-cell lung cancer (NSCLC). Methods The Geriatric Nutritional Risk Index (GNRI), calculated from body weight and serum albumin, was retrospectively evaluated in 148 patients with NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 61.8% [95% confidence interval {CI} = 52.5–70.3%] vs. 34.2% [95% CI = 21.2–50.1%, p < 0.004), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of longer PFS and OS, but not ORR, in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.