The role of geriatric nutritional risk index in predicting survival of type B aortic dissection patients after thoracic endovascular aortic repair

IF 4 3区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Nutrition Health & Aging Pub Date : 2025-05-14 DOI:10.1016/j.jnha.2025.100572

Kaiwen Zhao , Jinzhu Niu , Yuzhen He , Lingxu Kong , Wenyao Zhao , Qingsheng Lu , Shuangshuang Li , Jian Zhou

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引用次数: 0

Abstract

Background

The geriatric nutritional risk index (GNRI) is a reliable indicator of patients’ nutrition status and has been shown to be valuable in predicting the outcome of patients with various cardiovascular diseases. This study explored the association between perioperative GNRI and the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR).

Methods

A total of 1,157 consecutive patients who underwent TEVAR between January 2007 and August 2019 were included, with data from 789 patients analyzed. The GNRI was used to measure nutritional status. Patients were categorized into five groups based on the GNRI quintile. The study's endpoints included all-cause mortality, aortic-related adverse events (ARAEs), and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days, 1 year, and 5 years. The univariate and multivariate Cox regression analyses the effect of GNRI on the endpoints. Kaplan–Meier survival analysis was conducted to assess the incidence of these endpoints across the five groups, and restricted cubic spline (RCS) analysis was used to examine the non-linear relationship between GNRI and all-cause mortality.

Results

The Kaplan-Meier survival analyses revealed that the risk of 1-year and 5-year all-cause mortality was highest in the Q1 group among the five groups (P = 0.009 and P = 0.002, respectively). However, there was no significant difference in 1-year and 5-year ARAEs and MACCEs (all P > 0.05). Multivariate Cox analysis showed that continuous GNRI was independently associated with 5-year all-cause death (HR = 0.97, 95% CI: 0.95–1.00; P = 0.027). Compared with the Q1 group, the Q2 (HR = 0.22, 95% CI: 0.06−0.80; P = 0.021) and Q4 groups (HR = 0.26, 95% CI: 0.08−0.81; P = 0.020) had lower risks of 1-year all-cause mortality. The Q2 group (HR = 0.38, 95% CI: 0.18−0.83; P = 0.015) and Q3 group (HR = 0.46, 95% CI: 0.22−0.96; P = 0.039) were also observed to have a lower risk of 5-year all-cause mortality than the Q1 group. In the subgroup analyses, chronic kidney disease (CKD) showed significant interaction (P-interaction < 0.001). Besides, the RCS analysis identified a “U”-shaped relationship between GNRI and all-cause mortality of TBAD patients following TEAVR.

Conclusions

TBAD patients undergoing TEVAR showed a strong correlation between perioperative low GNRI and higher risks of 1-year and 5-year all-cause mortalities. TBAD patients with a too low GNRI should receive particular attention.

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老年营养风险指数在预测B型主动脉夹层胸血管内主动脉修复术后患者生存中的作用

老年营养风险指数（GNRI）是反映患者营养状况的可靠指标，在预测各种心血管疾病患者预后方面具有重要价值。本研究探讨B型主动脉夹层（TBAD）患者行胸腔血管内主动脉修复术（TEVAR）围手术期GNRI与预后的关系。方法纳入2007年1月至2019年8月期间连续接受TEVAR治疗的1157例患者，分析789例患者的数据。GNRI用于测量营养状况。根据GNRI五分位数将患者分为五组。该研究的终点包括30天、1年和5年的全因死亡率、主动脉相关不良事件（arae）和主要不良心脑血管事件（MACCEs）。单因素和多因素Cox回归分析了GNRI对终点的影响。采用Kaplan-Meier生存分析来评估五组中这些终点的发生率，并采用限制性三次样条（RCS）分析来检验GNRI与全因死亡率之间的非线性关系。结果Kaplan-Meier生存分析显示，Q1组患者1年和5年全因死亡风险最高（P = 0.009和P = 0.002）。然而，1年和5年的arae和MACCEs无显著差异（均P >； 0.05）。多因素Cox分析显示，连续GNRI与5年全因死亡独立相关(HR = 0.97, 95% CI: 0.95-1.00；p = 0.027)。与Q1组比较，Q2组(HR = 0.22, 95% CI: 0.06 ~ 0.80；P = 0.021)和第四季度组织(HR = 0.26, 95% CI: 0.08−0.81;P = 0.020) 1年全因死亡风险较低。Q2组(HR = 0.38, 95% CI: 0.18 ~ 0.83；P = 0.015)和第三季度集团(HR = 0.46, 95% CI: 0.22−0.96;P = 0.039)的5年全因死亡风险也低于Q1组。在亚组分析中，慢性肾脏疾病（CKD）表现出显著的相互作用(P-interaction <；0.001)。此外，RCS分析发现GNRI与TEAVR后TBAD患者全因死亡率呈“U”型关系。结论接受TEVAR治疗的stbad患者围手术期低GNRI与1年和5年全因死亡率增高有很强的相关性。GNRI过低的TBAD患者应受到特别关注。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nutrition Health & Aging 医学-老年医学

CiteScore

7.80

自引率

3.40%

发文量

136

审稿时长

4-8 weeks

期刊介绍： There is increasing scientific and clinical interest in the interactions of nutrition and health as part of the aging process. This interest is due to the important role that nutrition plays throughout the life span. This role affects the growth and development of the body during childhood, affects the risk of acute and chronic diseases, the maintenance of physiological processes and the biological process of aging. A major aim of "The Journal of Nutrition, Health & Aging" is to contribute to the improvement of knowledge regarding the relationships between nutrition and the aging process from birth to old age.