The correlation between geriatric nutritional risk index and concurrent delirium in the elderly patients with critical illness based on a propensity score matching study

Liu Dan; Chen Xiaofei; Liu Haitang

doi:10.3969/j.issn.1002-1949.2024.05.007

Abstract：Objective To analyze the correlation between the geriatric nutritional risk index(GNRI)and concurrent delirium in the elderly patients with critical illness based on a propensity score matching(PSM)study.Methods A total of 577 elderly patients with critical illness treated in the intensive care unit(ICU)of the Second Affiliated Hospital of Hainan Medical University from January 2021 to September 2023 were selected as study subjects,and the general data,clinical data and the GNRI on ICU admission of patients were collected.Receiver operating characteristic(ROC)curve analysis was performed to estimate the predictive value and optimal cut-off value of GNRI for concurrent delirium in the elderly patients with critical illness,and the patients were classified into low GNRI group(GNRI≤96.63)and high GNRI group(GNRI>96.63).PSM method was performed to balance clinical characteristics between two groups.The incidences of delirium in the elderly patients with critical illness between the two groups were compared after PSM,and Logistic regression analysis was used to evaluate the relationship between GNRI and delirium in the elderly patients with critical illness in the data before and after PSM.According to the data after PSM,the predictive efficacy of GNRI was further verified.Results ROC analysis revealed that the area under curve of GNRI for predicting the delirium in the elderly patients with critical illness was 0.748(95%CI 0.710-0.783,P<0.001)with a sensitivity of 70.29%and a specificity of 84.58%,when the optimal cut-off point was determined as 96.63.One hundred and sixty-eight elderly patients with critical illness were successfully matched after PSM.After matching,the baseline data in the low GNRI group and the high GNRI group were equally comparable.The incidence of delirium in low GNRI group was higher than that in high GNRI group after PSM[63.69%(107/168)vs.17.86%(30/168),χ2 =73.071,P<0.001).Logistic regression analysis showed that the decrease of GNRI was an independent risk factor of concurrent delirium in the elderly patients with critical illness in the data before and after PSM(P<0.05).The verified ROC analysis results showed that the area under curve of GNRI was 0.753(95%CI 0.704-0.798,P<0.001),and the sensitivity and the specificity was 69.64%and 85.12%with 96.44 as the optimal cut-off value.Conclusions The decrease of GNRI on ICU admission is an independent risk factor of concurrent delirium in the elderly patients with critical illness,and GNRI as a readily available nutritional status assessment tool could be used as a predictor for concurrent delirium in the elderly patients with critical illness.