老年营养风险指数与重症监护室慢性肾脏病患者住院死亡率的关联

Association of Geriatric Nutritional Risk Index with In-Hospital Mortality in Patients with Heart Failure in ICU

摘要: 目的：慢性肾脏病(CKD)患者常合并营养不良，且与预后密切相关。本研究旨在探讨老年营养风险指数(Geriatric Nutritional Risk Index, GNRI)对入住重症监护病房(ICU)CKD患者院内死亡率的预测价值，为临床风险评估和干预提供依据。方法：选取MIMIC-IV数据库中首次入住ICU且诊断为CKD的3404例患者，根据GNRI四分位数分为高风险组(846例)、中风险组(853例)、低风险组(850例)和无风险组(855例)。主要结局为住院期间死亡。采用单因素与多因素Logistic回归模型分析GNRI与院内死亡率的关系，并以GNRI中位数(103.2)为阈值进行亚组分析。结果：总体院内死亡率为18.4%，其中高风险组死亡率最高(27.3%)，无风险组最低(17.6%)，差异具有统计学意义(P < 0.001)。多因素回归分析显示，与高风险组相比，中风险组、低风险组和无风险组的死亡风险分别下降42%、53%和47%(OR分别为0.58、0.47、0.53，均P < 0.001)。亚组分析提示，GNRI < 103.2患者死亡风险显著增加(OR = 0.56，95%CI 0.47~0.67，P < 0.001)，血液透析治疗亚组间存在显著交互作用。结论：GNRI是ICU中CKD患者院内死亡率的独立预测因子。低GNRI提示更高死亡风险，尤其在非透析患者中预测效能更为显著。作为一种简便、客观的营养评估工具，本研究结果提示，GNRI在ICU慢性肾脏病患者中可作为院内死亡风险的一个独立预测指标，具有早期识别潜在高风险患者的价值，可为临床医生进一步开展全面营养与疾病评估提供线索。

Abstract: Objective: Patients with chronic kidney disease (CKD) are frequently complicated by malnutrition, which is closely associated with adverse outcomes. This study aimed to investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) for in-hospital mortality among CKD patients admitted to the intensive care unit (ICU), providing evidence for clinical risk assessment and intervention. Methods: A total of 3404 patients with a first ICU admission and a diagnosis of CKD were extracted from the MIMIC-IV database. According to GNRI quartiles, patients were categorized into a high-risk group (n = 846), moderate-risk group (n = 853), low-risk group (n = 850), and no-risk group (n = 855). The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to evaluate the association between GNRI and in-hospital mortality. Subgroup analyses were conducted using the GNRI median value (103.2) as the cutoff. Results: The overall in-hospital mortality was 18.4%, with the highest mortality observed in the high-risk group (27.3%) and the lowest in the no-risk group (17.6%) (P < 0.001). Multivariate analysis revealed that, compared with the high-risk group, the risk of mortality decreased by 42%, 53%, and 47% in the moderate-risk, low-risk, and no-risk groups, respectively (OR = 0.58, 0.47, and 0.53; all P < 0.001). Subgroup analysis indicated that patients with GNRI <103.2 had significantly higher mortality risk (OR = 0.56, 95% CI 0.47~0.67, P < 0.001), with a significant interaction observed in the subgroup of patients receiving hemodialysis. Conclusion: GNRI serves as an independent predictor of in-hospital mortality in CKD patients admitted to the ICU. A low GNRI indicates a higher risk of death, with particularly strong predictive value among non-dialysis patients. As a simple and objective nutritional assessment tool, GNRI may facilitate early identification of high-risk patients and guide individualized nutritional interventions, thereby improving outcomes in CKD patients.