Objective Assessment of Superiority of Enteral Feeding by Traditional Home Kitchen-Based Feed V/S Commercial Formula Feed in Patients of Esophagogastric Corrosive Injury

Background: Corrosive ingestion can cause severe chemical injury to upper gastrointestinal tract which leads to dysphagia, malnutrition and weight loss. Early nutritional assessment and support through feeding jejunostomy is important and it should be nutritionally optimum and economically balanced. The aim is to compare cost and nutritional status after nutritional support with traditional home kitchen made and commercial formula feed through feeding jejunostomy.Methods:A prospective study included patients on enteral nutrition based on traditional home kitchen feed (cohort-1) and on commercial formula feed (cohort-2). Patient’s body weight, BMI, haemoglobin, serum albumin, nutritional risk index, controlling nutritional status score were checked at the admission, 3rd and 6th month follow up.Results: In cohort 1 mean albumin and haemoglobin raised by 33.13% & 14.60% at 3rd month and 47.23% & 22.3% at 6th month respectively; In cohort 2 it was 9.12% & 2.69% at 3rd month and 17.62% & 6.53% at 6th month respectively. At 6th month in cohort 1 and 2 mean weight gain was 7.56% & 4.0%; mean increase in NRI was 34.78% & 11.5% respectively. Mean CONUT score at six months was better improved in cohort 1 which is 6 to 1 as compared to cohort 2 which was 6 to 3. Mean monthly cost of home-based feeds was significantly lower as compared to commercial feeds (62.14 Rs v/s 682-2354 Rs/day).Conclusions:In corrosive GI tract injury patient enteral nutrition with traditional home kitchen-based feeds is safe, cost effective and associated with better improvement in nutritional status objective parameters.

Nutritional Risk Index Predicts Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy

Nutritional risk index (NRI) is an index based on ideal body weight that aims to present body weight and serum albumin levels. It has been utilized to discriminate patients at risk of postoperative complications and predict the postoperative outcome of major surgeries. However, this index remains limited for breast cancer patients treated with neoadjuvant chemotherapy (NACT). The research explores the clinical and prognostic significance of NRI in breast cancer patients. This study included 785 breast cancer patients (477 cases received NACT and 308 cases did not) were enrolled in this retrospective study. The optimal NRI cutoff value was evaluated by receiver operating characteristic (ROC) curve, then reclassified as low NRI group (<112) and high NRI group (≥112). The results demonstrated that NRI independently predicted survival on disease-free survival (DFS) and overall survival (OS) by univariate and multivariate Cox regression survival analyses [P = 0.019, hazard ratio (HR): 1.521, 95% CI: 1.071–2.161 and P = 0.004, HR: 1.415, 95% CI: 1.119–1.789; and P = 0.026, HR:1.500, 95% CI: 1.051–2.143 and P < 0.001, HR: 1.547, 95% CI: 1.221–1.959]. According to the optimal cutoff value of NRI, the high NRI value patients had longer mean DFS and OS time in contrast to those with low NRI value patients (63.47 vs. 40.50 months; 71.50 vs. 56.39 months). Furthermore, the results demonstrated that the high NRI score patients had significantly longer mean DFS and OS time than those with low NRI score patients in early-stage breast cancer (χ2 = 9.0510, P = 0.0026 and χ2 = 9.2140, P = 0.0024) and advanced breast cancer (χ2 = 6.2500, P = 0.0124 and χ2 = 5.8880, P = 0.0152). The mean DFS and OS values in patients with high NRI scores were significantly longer in contrast to those with low NRI scores in different molecular subtypes. The common toxicities after NACT were hematologic and gastrointestinal reactions, and the NRI had no statistically significant effects on toxicities, except in nausea (χ2 = 9.2413, P = 0.0024), mouth ulcers (χ2 = 4.8133, P = 0.0282), anemia (χ2 = 8.5441, P = 0.0140), and leukopenia (χ2 = 11.0951, P = 0.0039). NRI serves as a minimally invasive, easily accessible and convenient prognostic tool for evaluating breast cancer prognoses and treatment efficacy, and may help doctors in terms of selecting measures of greater efficiency or appropriateness to better treat breast cancer.

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 Impact of Preoperative Nutritional Status on the Survival of Patients With Esophageal Squamous Cell Carcinoma

Background: The goal of this study was to investigate the impact of different nutritional parameters in patients with esophageal squamous cell carcinoma (ESCC) who underwent surgical resection.Methods: A total of 620 patients with ESCC who underwent esophagectomy were analyzed. A receiver operating characteristic curve was constructed to set the appropriate cutoff points for five nutritional parameters: serum albumin (SA), body mass index (BMI), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and a new modified nutritional risk index (mNRI). Survival analyses were performed to calculate overall survival and investigate the independent prognostic factors.Results: The median preoperative BMI, SA, GNRI, PNI, and mNRI values were 20.90, 42.75, 102.95, 51.90, and 63.90, respectively. The corresponding optimal cutoff points were 18.75 for BMI, 43.05 for SA, 98.5 for GNRI, 51.45 for PNI, and 61.45 for mNRI. All nutritional parameters were significantly correlated with tumor length and pT category. Decreased nutritional parameters were significantly correlated with poor survival in univariate analysis; however, only the mNRI was an independent prognostic factor in multivariate analysis (P = 0.041).Conclusions: Nutritional parameters are convenient and valuable prognostic factors in ESCC patients who undergo surgical resection. The new mNRI parameter may be superior to the other nutritional parameters.

Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: Malnutrition has been shown to be associated with adverse cardiovascular outcomes in many patient populations.Aims: To investigate the prognostic significance of malnutrition as defined by nutritional risk index (NRI) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and whether NRI could improve the GRACE score based prognostic models.Methods: This study applied NRI among 1,718 patients with ACS undergoing PCI. Patients were divided into three nutritional risk groups according to their baseline NRI: no nutritional risk (NRI ≥ 100), mild nutritional risk (97.5 ≤ NRI &lt;100), and moderate-to-severe nutritional risk (NRI &lt;97.5). The primary endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization.Results: During a median follow-up of 927 days, 354 patients developed MACE. In the overall population, compared with normal nutritional status, malnutrition was associated with increased risk for MACE [adjusted HR for mild and moderate-to-severe nutritional risk, respectively: 1.368 (95%CI 1.004–1.871) and 1.473 (95%CI 1.064–2.041)], and NRI significantly improved the predictive ability of the GRACE score for MACE (cNRI: 0.070, P = 0.010; IDI: 0.005, P &lt; 0.001). In the diabetes subgroup, malnutrition was associated with nearly 2-fold high adjusted risk of MACE, and the GRACE score combined with NRI appeared to have better predictive ability than that in the overall population.Conclusion: Malnutrition as defined by NRI was independently associated with MACE in ACS patients who underwent PCI, especially in individuals with diabetes, and improved the predictive ability of the GRACE score based prognostic models.

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.

Clinical Features of Patients With Heart Failure After the 2016 Kumamoto Earthquakes

Objective: Acute and chronic stress after severe earthquakes can contribute to cardiovascular events, including heart failure (HF). On April 14, 2016, magnitude 7 earthquakes occurred in the Aso region in the western part of Japan. This study aimed to investigate the clinical characteristics of HF in this area after these earthquakes. Methods: We investigated the clinical characteristics and 1-y mortality rate of patients with HF. Nutritional status was evaluated with the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI). Results: Among a total of 58 cardiovascular events, HF was the most frequently observed (n = 28). The mean age of individuals with HF was 85.5 y. The total incidence of HF was significantly higher compared with the average of the prior 2 y. Disaster influence on mental health was suggested by patient history in 20 patients (71%). The 1-y mortality rate among patients with HF was 50%. Among those who died, 93% had malnutrition status (GNRI <92 and /or PNI ≤38). Conclusions: Our results demonstrated the poor prognosis of patients with HF following the disaster. The prevalence of malnutrition was high in those patients. Careful follow-up is necessary, especially for older people with frailty.

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.

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR.Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint.Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints.Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.