老年营养风险指数预测老年尿脓毒症患者的短期死亡率：一项具有外部验证的回顾性队列研究
The geriatric nutritional risk index predicts short-term mortality in older patients with urosepsis: a retrospective cohort study with external validation.
摘要(中文译文)
尿源性脓毒症是尿路感染的严重并发症，与高死亡率相关，尤其是在老年人中。老年营养风险指数（GNRI）是一种简便的营养评估工具，但其在尿源性脓毒症中的特异性预后价值仍未被充分探讨。本回顾性队列研究纳入来自MIMIC-IV数据库（推导队列）的1，218例年龄≥65岁的尿源性脓毒症患者，以及来自外部医院的178例患者（验证队列）。采用GNRI对营养风险进行分级。使用Cox比例风险模型评估GNRI与28天ICU/住院死亡率之间的关联。采用ROC分析评估将GNRI加入现有严重程度评分后的增量预测价值。共纳入1，218例尿源性脓毒症患者。28天ICU死亡率和住院死亡率分别为18.7%和17.2%。经多变量调整后，较低的GNRI与28天ICU死亡率升高独立相关（调整后HR = 0.96，95% CI：0.94-0.98，< 0.001）及住院死亡率升高独立相关（调整后HR = 0.96，95% CI：0.94-0.98，< 0.001）。高GNRI风险组患者的死亡率显著高于无风险组（ICU死亡率：调整后HR = 2.34，95% CI：1.07-5.11，= 0.034；住院死亡率：调整后HR = 2.63，95% CI：1.05-6.58，= 0.039）。加入GNRI显著提高了所有六种严重程度评分的预测准确性（例如，SOFA的AUC从0.625提高至0.709，< 0.001）。亚组分析显示，在大多数人口学特征和合并症中趋势一致。这些发现在外部队列中得到验证，其中较高的GNRI仍对28天死亡率具有保护作用（调整后HR = 0.95，95% CI：0.91-1.00，= 0.033）。GNRI是老年尿源性脓毒症患者短期死亡率的独立预测因子，并可提高现有严重程度评分的预后准确性。早期营养评估和干预可能改善这一高危人群的结局。
Abstract
Urosepsis, a severe complication of urinary tract infection, is associated with high mortality, especially in older adults. The Geriatric Nutritional Risk Index (GNRI) is a simple nutritional assessment tool, but its prognostic value specifically in urosepsis remains underexplored. This retrospective cohort study included 1,218 patients aged ≥65 years with urosepsis from the MIMIC-IV database (derivation cohort) and 178 patients from an external hospital (validation cohort). Nutritional risk was categorized using GNRI. Cox proportional hazards models were used to assess the association between GNRI and 28-day ICU/in-hospital mortality. The incremental predictive value of GNRI added to established severity scores was evaluated using ROC analysis. A total of 1,218 urosepsis patients were included. The 28-day ICU mortality and in-hospital mortality rates were 18.7 and 17.2%. After multivariable adjustment, lower GNRI was independently associated with increased 28-day ICU mortality (adjusted HR = 0.96, 95% CI: 0.94-0.98, < 0.001) and in-hospital mortality (adjusted HR = 0.96, 95% CI: 0.94-0.98, < 0.001). Patients in the high GNRI-risk group had significantly higher mortality compared to the no-risk group (ICU mortality: adjusted HR = 2.34, 95% CI: 1.07-5.11, = 0.034; in-hospital mortality: adjusted HR = 2.63, 95% CI: 1.05-6.58, = 0.039). Adding GNRI significantly improved the predictive accuracy of all six severity scores (e.g., SOFA AUC increased from 0.625 to 0.709, < 0.001). Subgroup analyses showed consistent trends across most demographics and comorbidities. These findings were validated in the external cohort, where a higher GNRI remained protective against 28-day mortality (adjusted HR = 0.95, 95% CI: 0.91-1.00, = 0.033). GNRI is an independent predictor of short-term mortality in older patients with urosepsis and enhances the prognostic accuracy of existing severity scores. Early nutritional assessment and intervention may improve outcomes in this high-risk population.
如何引用
AMA
Lihua Zhu, Zirong Gao, Ying Yu, Zhen Wu, Yafang Diao, Junhua Zhang, et al. The geriatric nutritional risk index predicts short-term mortality in older patients with urosepsis: a retrospective cohort study with external validation.. Frontiers in nutrition. 2026; doi:10.3389/fnut.2026.1793046.
APA
Lihua Zhu, Zirong Gao, Ying Yu, Zhen Wu, Yafang Diao, Junhua Zhang, et al (2026). The geriatric nutritional risk index predicts short-term mortality in older patients with urosepsis: a retrospective cohort study with external validation.. Frontiers in nutrition. https://doi.org/10.3389/fnut.2026.1793046
GB/T 7714
Lihua Zhu, Zirong Gao, Ying Yu, Zhen Wu, Yafang Diao, Junhua Zhang, et al. The geriatric nutritional risk index predicts short-term mortality in older patients with urosepsis: a retrospective cohort study with external validation.[J]. Frontiers in nutrition, 2026 doi:10.3389/fnut.2026.1793046.
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