Geriatric Nutrition Risk Index Correlates with Anthropometric, Laboratory Measures and Hospital Length of Stay in Elderly Patients Admitted to Geriatric Hospital, Ain Shams University
Authors: Mohammed Hebatullah O , Hassan Azza M , Mostafa Aya , Khater Mohamed S , Aboelfotoh Aisha , Abd Elaziz Khaled M 
Published: November 2024

Abstract

Background
Elderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The medical and economic consequences of malnutrition in hospitalized patients are therefore often underestimated. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized elderly patients.

Objectives
This study investigates firstly whether the GNRI correlates with anthropometric, laboratory markers, and hospital length of hospital stay (LOS) in older inpatients. Secondly the association between nutritional risk and hospital mortality.

Methods
A hospital-based cross-sectional study was conducted among 334 elderly hospitalized patients over 60 years of age admitted to the geriatric hospital ward, Ain Shams University from August 2021 to May 2022. The following data were obtained within 48 hours after hospital admission: socio-demographic characteristics, anthropometric measures, laboratory markers levels, and nutritional risk assessment by GNRI score. Patients were divided into three groups based on their GNRI score: high nutritional risk (GNRI &lt; 92), low nutritional risk (92-98), and no risk group (GNRI &gt; 98). Patients were followed up for the occurrence of different adverse clinical outcomes starting from the date of assessment and during hospitalization days. The endpoints of this study were hospital LOS and hospital mortality.

Results
The mean age of the studied elderly was 72.35 + 8.1 years, (55.7%) were females. The prevalence of high, low, and no nutritional risk as measured by GNRI was 45.5%, 18%, and 36.5%, respectively with a mean value of 95.07 + 13.63. The average body mass index (BMI) was 26.32 + 4.94. The median LOS stay was 10 days (IQR = 8) and it significantly increased in patients with no, low, and high risk from 8 to 10 and 12 days, respectively. GNRI was positively correlated to serum albumin levels, haemoglobin, BMI, skin fold thickness, Mid Arm Circumference, and Calf Circumference (p &lt; 0.05). Moreover, we found a negative correlation between GNRI and age, C-reactive protein (CRP), ferritin, and LOS, (p &lt; 0.001). Hospital mortality significantly increases as nutritional risk increases as the incidence of hospital deaths among patients of the high-risk group was (15.1%) compared to (3.3%) mortality rate in the no-risk group (P &lt; 0.05).

Conclusions
The GNRI correlates well with anthropometric measures, laboratory markers levels, and the hospital LOS. High nutritional risk was associated with increased hospital mortality. GNRI may serve as a simple, objective, and rapid screening tool to identify the high nutritional risk for mortality in hospitalized elderly patients.