老年营养风险指数与老年癌症及非癌症患者住院时间的关系研究

目的 应用老年营养风险指数(GNRI)评估患者的营养风险，探讨其与老年癌症及非癌症患者住院时间的关系。方法 选择老年住院患者37 267例，将其分为癌症组和非癌症组，应用GNRI评估患者入院时的营养风险；以患者死亡及出院为观察终点，住院时间(d)作为临床结局指标，采用边际结构模型探讨GNRI与老年癌症及非癌症患者住院时间的关联性。结果 超过一半(56.3%)的老年住院患者具有不同程度的营养风险；与非癌症患者相比，癌症患者GNRI水平(91.0±10.2)及无营养风险患者的比例(26.8%)更低，而具有低(24.6%)、中(29.0%)、高(19.7%)营养风险患者的比例均更高，差异均具有统计学意义(P＜0.05)。在控制其他混杂因素后，边际结构模型分析结果显示在癌症和非癌症患者中，住院时间均随营养风险程度的升高而延长，具有高营养风险的癌症患者住院时间最长，高达19.1(95% CI:17.5~20.8)d；在不同的营养风险分组中，癌症患者住院时间(14.5~19.1 d)均高于非癌症患者(10.1~15.2 d)，差异均具有统计学意义(P＜0.05)。结论 GNRI 适用于老年癌症及非癌症患者的营养风险筛查评估，由GNRI评估的营养风险越高，患者住院时间越长。

Association between Geriatric Nutritional Risk Index and length of hospital stay in elderly patients with and without cancer

Objective To assess the nutritional risk of inpatients with Geriatric Nutritional Risk Index (GNRI) and to explore the association between GNRI and length of hospital stay (LOS) in elderly patients with and without cancer. Methods A total of 37,267 elderly inpatients were divided into cancer group and non-cancer group, GNRI was used to assess the nutritional risk of inpatients at admission. Taking death and discharge as the endpoints and LOS (d) as the clinical outcome indicator, the marginal structural model was used to explore the association between GNRI and LOS in elderly patients with and without cancer. Results More than half (56.3%) of the elderly patients had different levels of nutritional risk. Compared with the non-cancer group, the level of GNRI (91.0±10.2) and the proportion of no nutritional risk (26.8%) in the cancer group was lower, while the proportion of patients with low (24.6%), medium (29.0%) and high (19.7%) nutritional risk was higher, the differences were statistically significant (P<0.05). After controlling for other confounding factors, the results of the marginal structural model analysis showed that the LOS was prolonged with the increase of nutritional risk in both cancer and non-cancer groups, and the longest LOS ［19.1(95% CI: 17.5-20.8) d］ was found in cancer group with the highest nutritional risk. In different nutritional risk groups, the LOS of the cancer group (14.5-19.1 d) was higher than that of the non-cancer group (10.1-15.2 d), and the differences were statistically significant (P<0.05). Conclusion GNRI is suitable for nutritional risk screening and assessment in elderly patients with and without cancer. The LOS is prolonged with the elevated nutritional risk assessed by GNRI.