Comparison of Nutrition Indices for Prognostic Utility in Patients with Sepsis: A Real-World Observational Study
Django Kyo, Shiho Tokuoka, Shunsuke Katano, Ryo Hisamune, Hidero Yoshimoto, Shuhei Murao, Yutaka Umemura, Akira Takasu, Kazuma Yamakawa
Abstract
BACKGROUND: Nutritional status of critically ill patients is an important factor affecting complications and mortality. This study aimed to investigate the impact of three nutritional indices, the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT), on mortality in patients with sepsis in Japan. METHODS: This retrospective observational study used the Medical Data Vision database containing data from 42 acute-care hospitals in Japan. We extracted data on baseline characteristics on admission. GNRI, PNI, and CONUT scores on admission were also calculated. To evaluate the significance of these three nutritional indices on mortality, we used logistic regression to fit restricted cubic spline models and constructed Kaplan-Meier survival curves. RESULTS: We identified 32,159 patients with sepsis according to the inclusion criteria. Of them, 1804 patients were treated in intensive care units, and 3461 patients were non-survivors. When the GNRI dropped below 100, the risk of mortality rose sharply, as did that when the PNI dropped below about 40. An increased CONUT score was associated with increased mortality in an apparent linear manner. CONCLUSION: In sepsis management, GNRI and PNI values may potentially be helpful in identifying patients with a high risk of death.