Predictive value of geriatric nutritional risk index for pulmonary infections in hospitalized elderly patients with type 2 diabetes mellitus

doi:10.3969/j.issn.1674-8115.2025.04.007

Abstract

Abstract:

Objective ·To investigate the predictive value of the geriatric nutritional risk index (GNRI) for the occurrence of lung infection in hospitalized elderly patients with type 2 diabetes mellitus (T2DM). Methods ·Elderly T2DM patients who were admitted to the Geriatric Department of Shanghai Tongren Hospital between June 2022 and June 2024 were retrospectively and consecutively enrolled. They were divided into infected and non-infected groups according to whether lung infection occurred during hospitalization. Baseline data (gender, age, height, weight, duration of diabetes, comorbidities, etc.) were collected and GNRI was calculated. A multivariate Logistic regression model was used to screen the independent risk factors for pulmonary infections,and the predictive value of GNRI for pulmonary infections in T2DM patients was analysed using receiver operating characteristic (ROC) curves. Results ·A total of 264 elderly T2DM patients were enrolled, among whom 154 developed pulmonary infections. Significant differences were observed between the infected and non-infected groups in GNRI, albumin, leukocyte count, neutrophil ratio, lymphocyte ratio, glycated hemoglobin, fasting glucose, interleukin-6, C-reactive protein, and procalcitonin levels (P<0.05). Multivariate Logistic regression analysis showed that a lower GNRI was an independent risk factor for lung infection (OR=0.798, 95%CI 0.712‒0.894; P<0.001). Correlation analysis showed that GNRI was negatively correlated with C-reactive protein and calcitoninogen. ROC curve analysis showed that GNRI predicted pulmonary infection with an area under the curve of 0.828, a sensitivity of 77.9%, and a specificity of 76.6%. Conclusion ·A lower GNRI is an independent risk factor for pulmonary infections in elderly T2DM patients, and also has a good predictive value for the occurrence of pulmonary infections.

Key words: geriatric nutritional risk index (GNRI), type 2 diabetes mellitus (T2DM), lung infection, predictive value

CLC Number:

R587.1

LIAN Mingzhu, ZHANG Changxiao, SHENG Kai, GUO Meng, FANG Shuyu. Predictive value of geriatric nutritional risk index for pulmonary infections in hospitalized elderly patients with type 2 diabetes mellitus[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 452-458.

Figures/Tables 5

TrendMD

References 19

1	ZHAO Y L, LIN T P, HOU L S, et al. Association between geriatric nutritional risk index and frailty in older hospitalized patients[J]. Clin Interv Aging, 2021, 16: 1241-1249.
2	TAMURA Y, OMURA T, TOYOSHIMA K, et al. Nutrition management in older adults with diabetes: a review on the importance of shifting prevention strategies from metabolic syndrome to frailty[J]. Nutrients, 2020, 12(11): 3367.
3	LISCO G, GIAGULLI V A, DE PERGOLA G, et al. Chronic stress as a risk factor for type 2 diabetes: endocrine, metabolic, and immune implications[J]. Endocr Metab Immune Disord Drug Targets, 2024, 24(3): 321-332.
4	任明, 吕岩, 代云峰, 等. 老年糖尿病合并肺部感染患者病原菌分布特点和药敏试验[J]. 中国老年学杂志, 2022, 42(22): 5475-5477.
	REN M, LÜ Y, DAI Y F, et al. Distribution characteristics of pathogenic bacteria and drug sensitivity test in elderly patients with diabetes mellitus combined with lung infection[J]. Chinese Journal of Gerontology, 2022, 42(22): 5475-5477.
5	吴思, 张赟锋. 老年2型糖尿病合并肺部感染患者的预后危险因素[J]. 老年医学与保健, 2024, 30(1): 33-37, 49.
	WU S, ZHANG Y F. Prognostic risk factors in elderly patients with type 2 diabetes mellitus complicated with pulmonary infection[J]. Geriatrics & Health Care, 2024, 30(1): 33-37, 49.
6	BOUILLANNE O, MORINEAU G, DUPONT C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients[J]. Am J Clin Nutr, 2005, 82(4): 777-783.
7	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中国糖尿病杂志, 2014, 22(8): 2-42.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2013 edition)[J]. Chinese Journal of Diabetes, 2014, 22(8): 2-42.
8	中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版)[J]. 中华临床感染病杂志, 2023, 16(1): 1-9.
	National Health Commission of the People' s Republic of China. Diagnosis and treatment plan for COVID-19 (trial version 10)[J]. Chinese Journal of Clinical Infectious Diseases, 2023, 16(1): 1-9.
9	邱玥, 孙鼎, 陆艳. 老年营养风险指数对老年肝癌患者术后并发症的预测价值[J]. 中国老年学杂志, 2022, 42(20): 4958-4961.
	QIU Y, SUN D, LU Y. Predictive value of the geriatric nutritional risk index for postoperative complications in elderly patients with hepatocellular carcinoma[J]. Chinese Journal of Gerontology, 2022, 42(20): 4958-4961.
10	HUA J, HUANG P, LIAO H H, et al. Prevalence and clinical significance of occult pulmonary infection in elderly patients with type 2 diabetes mellitus[J]. Biomed Res Int, 2021, 2021: 3187388.
11	朱洋, 李建如, 赵淼, 等. 老年肺部感染患者营养状态的临床研究[J]. 中国临床保健杂志, 2022, 25(5): 689-692.
	ZHU Y, LI J R, ZHAO M, et al. Investigation on the relationship between pulmonary infection and nutritional status in elderly patients[J]. Chinese Journal of Clinical Healthcare, 2022, 25(5): 689-692.
12	RASHEEDY D, EL-KAWALY W H. The accuracy of the Geriatric Nutritional Risk Index in detecting frailty and sarcopenia in hospitalized older adults[J]. Aging Clin Exp Res, 2020, 32(12): 2469-2477.
13	CIACCIO M. Introduction of glycated albumin in clinical practice[J]. J Lab Precis Med, 2019, 4: 28.
14	YENIBERTIZ D, CIRIK M O. The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure[J]. Aging Clin Exp Res, 2021, 33(3): 611-617.
15	LEE C M, WOODWARD M, BATTY G D, et al. Association of anthropometry and weight change with risk of dementia and its major subtypes: a meta-analysis consisting 2.8 million adults with 57 294 cases of dementia[J]. Obes Rev, 2020, 21(4): e12989.
16	姜逍瑶, 王春晴, 赵旭东. 老年营养风险指数对缺血性卒中相关性肺炎的预测价值[J]. 国际脑血管病杂志, 2024, 32(2): 88-93.
	JIANG X Y, WANG C Q, ZHAO X D. Predictive value of geriatric nutritional risk index for ischemic stroke-associated pneumonia[J]. International Journal of Cerebrovascular Diseases, 2024, 32(2): 88-93.
17	戴慧芳, 李海, 苏小游, 等. 老年营养风险指数对2型糖尿病骨质疏松症的预测价值[J]. 浙江医学, 2022, 44(8): 831-836.
	DAI H F, LI H, SU X Y, et al. Predictive value of geriatric nutritional risk index for osteoporosis in patients with type 2 diabetes mellitu[J]. Zhejiang Medical Journal, 2022, 44(8): 831-836.
18	麦合甫热提·乌甫尔, 张家丽, 穆叶赛·尼加提. 基于老年营养风险指数构建老年医院获得性肺炎的预后模型[J]. 中国医药导报, 2021, 18(8): 29-33.
	MAIHEVZETI U, ZHANG J L, MUYEXAY N. Prognostic model of hospital acquired pneumonia in the elderly based on geriatric nutritional risk index[J]. China Medicine Herald, 2021, 18(8): 29-33.
19	ABD-EL-GAWAD W M, ABOU-HASHEM R M, EL MARAGHY M O, et al. The validity of geriatric nutrition risk index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. comparison with mini nutritional assessment[J]. Clin Nutr, 2014, 33(6): 1108-1116.

Item	Total sample (n=264)	Non-infected group (n=110)	Infected group (n=154)	t/Z/χ² value	P
Age/year	88.37±8.92	91.17±4.50	86.36±10.62	5.023	<0.001
GNRI	94.75±8.10	100.11±7.55	90.91±6.07	10.956	<0.001
Height/m	1.67±0.08	1.66±0.09	1.67±0.08	-1.627	0.105
Body mass/kg	63.92±10.77	67.13±10.58	61.62±10.34	4.221	<0.001
WBC/(×10⁹·L^-1)	8.52±2.99	6.21±1.56	10.17±2.65	-15.220	<0.001
NEUT/%	68.40±11.80	61.04±7.49	73.65±11.52	-10.770	<0.001
LYMPH/%	20.58±9.27	25.64±6.96	16.96±9.03	8.819	<0.001
HbA1c/%	7.67±0.86	7.51±0.76	7.78±0.92	-2.540	0.012
FBG/(mmol·L^-1)	8.18±1.43	7.55±1.22	8.63±1.40	-6.682	<0.001
ALB/(g·L^-1)	34.35±3.50	36.07±3.04	33.11±3.28	7.445	<0.001
IL-6/(pg·ml^-1)	10.00 (5.86, 18.00)	5.35 (3.45, 7.35)	15.00 (10.00, 22.04)	-10.441	<0.001
CRP/(mg·L^-1)	10.21 (5.40, 33.25)	5.60 (4.65, 7.00)	26.03 (13.32, 50.10)	-10.935	<0.001
PCT/(ng·ml^-1)	0.10 (0.05, 0.23)	0.06 (0.04, 0.15)	0.15 (0.06, 0.33)	-4.731	<0.001
Diabetic duration/year	4.00 (1.00, 9.00)	4.00 (1.00, 9.00)	3.50 (1.00, 8.00)	-0.710	0.480
Gender/n(%)				0.650	0.420
Male	158 (59.8)	69 (62.7)	89 (57.8)
Female	106 (40.2)	41 (37.3)	65 (42.2)
CHD/n(%)				20.533	<0.001
No	48 (18.2)	6 (5.5)	42 (27.3)
Yes	216 (81.8)	104 (94.5)	112 (72.7)
Hypertension/n(%)				0.804	0.370
No	55 (20.83)	20 (18.2)	35 (22.7)
Yes	209 (79.2)	90 (81.8)	119 (77.3)
Chronic bronchitis/n(%)				35.418	<0.001
No	130 (49.2)	78 (70.9)	52 (33.8)
Yes	134 (50.8)	32 (29.1)	102 (66.2)
Diabetic nephropathy/n(%)				0.700	0.403
No	212 (80.3)	91 (82.7)	121 (78.6)
Yes	52 (19.7)	19 (17.3)	33 (21.4)
Peripheral vascular disease of diabetes/n(%)				0.800	0.370
No	209 (79.2)	90 (81.8)	119 (77.3)
Yes	55 (20.8)	20 (18.2)	35 (22.7)
Diabetic foot/n(%)				0.860	0.355
No	245 (92.8)	104 (94.6)	141 (91.6)
Yes	19 (7.2)	6 (5.4)	13 (8.4)

Item	Total sample (n=264)	Non-infected group (n=110)	Infected group (n=154)	t/Z/χ² value	P
Age/year	88.37±8.92	91.17±4.50	86.36±10.62	5.023	<0.001
GNRI	94.75±8.10	100.11±7.55	90.91±6.07	10.956	<0.001
Height/m	1.67±0.08	1.66±0.09	1.67±0.08	-1.627	0.105
Body mass/kg	63.92±10.77	67.13±10.58	61.62±10.34	4.221	<0.001
WBC/(×10⁹·L^-1)	8.52±2.99	6.21±1.56	10.17±2.65	-15.220	<0.001
NEUT/%	68.40±11.80	61.04±7.49	73.65±11.52	-10.770	<0.001
LYMPH/%	20.58±9.27	25.64±6.96	16.96±9.03	8.819	<0.001
HbA1c/%	7.67±0.86	7.51±0.76	7.78±0.92	-2.540	0.012
FBG/(mmol·L^-1)	8.18±1.43	7.55±1.22	8.63±1.40	-6.682	<0.001
ALB/(g·L^-1)	34.35±3.50	36.07±3.04	33.11±3.28	7.445	<0.001
IL-6/(pg·ml^-1)	10.00 (5.86, 18.00)	5.35 (3.45, 7.35)	15.00 (10.00, 22.04)	-10.441	<0.001
CRP/(mg·L^-1)	10.21 (5.40, 33.25)	5.60 (4.65, 7.00)	26.03 (13.32, 50.10)	-10.935	<0.001
PCT/(ng·ml^-1)	0.10 (0.05, 0.23)	0.06 (0.04, 0.15)	0.15 (0.06, 0.33)	-4.731	<0.001
Diabetic duration/year	4.00 (1.00, 9.00)	4.00 (1.00, 9.00)	3.50 (1.00, 8.00)	-0.710	0.480
Gender/n(%)				0.650	0.420
Male	158 (59.8)	69 (62.7)	89 (57.8)
Female	106 (40.2)	41 (37.3)	65 (42.2)
CHD/n(%)				20.533	<0.001
No	48 (18.2)	6 (5.5)	42 (27.3)
Yes	216 (81.8)	104 (94.5)	112 (72.7)
Hypertension/n(%)				0.804	0.370
No	55 (20.83)	20 (18.2)	35 (22.7)
Yes	209 (79.2)	90 (81.8)	119 (77.3)
Chronic bronchitis/n(%)				35.418	<0.001
No	130 (49.2)	78 (70.9)	52 (33.8)
Yes	134 (50.8)	32 (29.1)	102 (66.2)
Diabetic nephropathy/n(%)				0.700	0.403
No	212 (80.3)	91 (82.7)	121 (78.6)
Yes	52 (19.7)	19 (17.3)	33 (21.4)
Peripheral vascular disease of diabetes/n(%)				0.800	0.370
No	209 (79.2)	90 (81.8)	119 (77.3)
Yes	55 (20.8)	20 (18.2)	35 (22.7)
Diabetic foot/n(%)				0.860	0.355
No	245 (92.8)	104 (94.6)	141 (91.6)
Yes	19 (7.2)	6 (5.4)	13 (8.4)

Item	OR	95% CI	P value
Age	0.843	0.743‒0.957	0.008
GNRI	0.798	0.712‒0.894	<0.001
LYMPH	0.928	0.852‒1.010	0.084
HbA1c	1.368	0.605‒3.091	0.451
FBG	1.232	0.697‒2.179	0.473
IL-6	1.176	1.032‒1.340	0.015
CRP	1.374	1.182‒1.597	<0.001
PCT	3.232	0.252‒41.508	0.368
CHD	1.280	0.098‒16.709	0.850
Chronic bronchitis	4.938	1.126‒21.652	0.034

Item	OR	95% CI	P value
Age	0.843	0.743‒0.957	0.008
GNRI	0.798	0.712‒0.894	<0.001
LYMPH	0.928	0.852‒1.010	0.084
HbA1c	1.368	0.605‒3.091	0.451
FBG	1.232	0.697‒2.179	0.473
IL-6	1.176	1.032‒1.340	0.015
CRP	1.374	1.182‒1.597	<0.001
PCT	3.232	0.252‒41.508	0.368
CHD	1.280	0.098‒16.709	0.850
Chronic bronchitis	4.938	1.126‒21.652	0.034

Parameter	Value	95%CI
AUC	0.828	0.777‒0.872
SE	0.026	N/A
Yuden-index	0.543	0.420‒0.626
Cut-off	94.727	93.870‒99.820
Sensitivity/%	77.9	70.5‒84.2
Specificity/%	76.6	67.3‒83.9
PPV/%	82.2	76.6‒86.7
NPV/%	71.2	64.3‒77.2