{"title":"老年人营养风险指数作为日本老年患者艰难梭菌感染复发的危险因素。","authors":"Hideki Kumagai, Yoshihiro Shioi, Daichi Tamura, Toshiki Shitomi, Chihiro Tono","doi":"10.2185/jrm.2022-027","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective:</b> Old age is a risk factor for <i>Clostridioides difficile</i> infection (CDI). As the world's aging population increases, identifying risk factors for CDI in elderly patients is a matter of urgency. This study examined the relationship between CDI relapse and nutritional status using the geriatric nutritional risk index (GNRI). <b>Patients and Methods:</b> Between January 2016 and December 2021, 108 patients were diagnosed with CDI. Of the 108 patients, 19 were excluded because of younger age (<65 years), early death within 14 days of the initial CDI diagnosis, and insufficient data. The patients were divided into low- (<75) and high-GNRI groups (≥75) based on the receiver operating characteristic curve analysis. Variables associated with CDI relapse were also analyzed. <b>Results:</b> The median GNRI scores in all patients and in the low- and high-GNRI groups were 74.9, 68.9, and 83.9, respectively. Of the 89 patients, 28 (31.8%) experienced a CDI relapse. The log-rank test showed a significantly better relapse-free survival (RFS) in the high GNRI group (<i>P</i>=0.002). Univariate analysis revealed that low GNRI (<i>P</i>=0.004), chronic kidney disease (CKD) (<i>P</i>=0.004), and beta-lactamase inhibitor administration before the initial diagnosis of CDI (<i>P</i>=0.025) were significantly correlated with RFS. Multivariate analysis revealed that low GNRI (<i>P</i>=0.008) and CKD (<i>P</i>=0.010) were independent prognostic factors for RFS. <b>Conclusion:</b> Among elderly patients, a low GNRI was strongly associated with CDI relapse. Our study may help clinicians to consider therapeutic strategies for elderly patients with CDI.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"17 4","pages":"248-254"},"PeriodicalIF":0.0000,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/56/jrm-17-248.PMC9613364.pdf","citationCount":"0","resultStr":"{\"title\":\"Geriatric nutritional risk index as a risk-factor for <i>Clostridioides difficile</i> infection relapse in elderly Japanese patients.\",\"authors\":\"Hideki Kumagai, Yoshihiro Shioi, Daichi Tamura, Toshiki Shitomi, Chihiro Tono\",\"doi\":\"10.2185/jrm.2022-027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objective:</b> Old age is a risk factor for <i>Clostridioides difficile</i> infection (CDI). As the world's aging population increases, identifying risk factors for CDI in elderly patients is a matter of urgency. This study examined the relationship between CDI relapse and nutritional status using the geriatric nutritional risk index (GNRI). <b>Patients and Methods:</b> Between January 2016 and December 2021, 108 patients were diagnosed with CDI. Of the 108 patients, 19 were excluded because of younger age (<65 years), early death within 14 days of the initial CDI diagnosis, and insufficient data. The patients were divided into low- (<75) and high-GNRI groups (≥75) based on the receiver operating characteristic curve analysis. Variables associated with CDI relapse were also analyzed. <b>Results:</b> The median GNRI scores in all patients and in the low- and high-GNRI groups were 74.9, 68.9, and 83.9, respectively. Of the 89 patients, 28 (31.8%) experienced a CDI relapse. The log-rank test showed a significantly better relapse-free survival (RFS) in the high GNRI group (<i>P</i>=0.002). Univariate analysis revealed that low GNRI (<i>P</i>=0.004), chronic kidney disease (CKD) (<i>P</i>=0.004), and beta-lactamase inhibitor administration before the initial diagnosis of CDI (<i>P</i>=0.025) were significantly correlated with RFS. Multivariate analysis revealed that low GNRI (<i>P</i>=0.008) and CKD (<i>P</i>=0.010) were independent prognostic factors for RFS. <b>Conclusion:</b> Among elderly patients, a low GNRI was strongly associated with CDI relapse. Our study may help clinicians to consider therapeutic strategies for elderly patients with CDI.</p>\",\"PeriodicalId\":73939,\"journal\":{\"name\":\"Journal of rural medicine : JRM\",\"volume\":\"17 4\",\"pages\":\"248-254\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/56/jrm-17-248.PMC9613364.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of rural medicine : JRM\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2185/jrm.2022-027\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/10/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of rural medicine : JRM","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2185/jrm.2022-027","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/10/22 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
Geriatric nutritional risk index as a risk-factor for Clostridioides difficile infection relapse in elderly Japanese patients.
Objective: Old age is a risk factor for Clostridioides difficile infection (CDI). As the world's aging population increases, identifying risk factors for CDI in elderly patients is a matter of urgency. This study examined the relationship between CDI relapse and nutritional status using the geriatric nutritional risk index (GNRI). Patients and Methods: Between January 2016 and December 2021, 108 patients were diagnosed with CDI. Of the 108 patients, 19 were excluded because of younger age (<65 years), early death within 14 days of the initial CDI diagnosis, and insufficient data. The patients were divided into low- (<75) and high-GNRI groups (≥75) based on the receiver operating characteristic curve analysis. Variables associated with CDI relapse were also analyzed. Results: The median GNRI scores in all patients and in the low- and high-GNRI groups were 74.9, 68.9, and 83.9, respectively. Of the 89 patients, 28 (31.8%) experienced a CDI relapse. The log-rank test showed a significantly better relapse-free survival (RFS) in the high GNRI group (P=0.002). Univariate analysis revealed that low GNRI (P=0.004), chronic kidney disease (CKD) (P=0.004), and beta-lactamase inhibitor administration before the initial diagnosis of CDI (P=0.025) were significantly correlated with RFS. Multivariate analysis revealed that low GNRI (P=0.008) and CKD (P=0.010) were independent prognostic factors for RFS. Conclusion: Among elderly patients, a low GNRI was strongly associated with CDI relapse. Our study may help clinicians to consider therapeutic strategies for elderly patients with CDI.