Geriatric Nutritional Risk Index as a Predictor of Delirium and Pressure Injuries in Critically Ill Older Patients With Ischaemic Stroke: An Observational Cohort Study.

Background: Malnutrition is a prevalent phenomenon among patients with ischaemic stroke, and it is associated with a multitude of adverse health outcomes.

Aim: To evaluate the Geriatric Nutritional Risk Index (GNRI) as a predictor of both delirium and pressure injuries in critically ill older adults with ischaemic stroke.

Study design: An observational cohort study of 969 patients with ischaemic stroke conducted at a tertiary academic medical centre in the United States, divided into two groups based on GNRI scores: at risk of malnutrition (GNRI ≤ 98) and not at risk (GNRI > 98). Delirium was assessed via the Confusion Assessment Method for the Intensive Care Unit and nursing notes; pressure injuries were identified through direct clinical observation using the International Pressure Injury Staging System. Multivariable logistic regression, propensity score matching, and inverse probability of treatment weighting were used for analysis.

Results: Patients at risk for malnutrition had a significantly higher prevalence of delirium and pressure injuries compared with those not at risk (66.4% vs. 46.4% for delirium and 30.3% vs. 9.7% for pressure injuries, both p < 0.001). Multivariable analysis showed that lower GNRI scores were significantly associated with increased risks of both delirium (OR: 1.75, 95% CI: 1.28-2.40, p < 0.001) and pressure injuries (OR: 2.70, 95% CI: 1.79-4.09, p < 0.001). The results remained consistent even after propensity score matching and inverse probability of treatment weighting analyses.

Conclusions: The study shows that the GNRI is an effective predictor of the risk of pressure injury and delirium in older adults with ischaemic stroke.

Relevance to clinical practice: The assessment and management of nutritional status using GNRI in clinical practice has the potential to facilitate the early detection of high-risk patients and the implementation of targeted nutritional interventions.