预测福尼尔坏疽死亡率的老年营养风险指数:转诊中心14年统计数据的分析。

IF 2.9 Q1 EMERGENCY MEDICINE Archives of Academic Emergency Medicine Pub Date : 2024-09-22 eCollection Date: 2025-01-01 DOI:10.22037/aaem.v13i1.2408
Amir Alinejad Khorram, Seyyed Ali Hojjati, Fatemeh Sodeifian, Roya Kolahchi, Mohammad Farjami, Hossein Rahnama, Farzad Allameh
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引用次数: 0

摘要

简介福尼尔坏疽(Fournier's gangrene,FG)是一种影响外生殖器或会阴的坏死性筋膜炎。据报道,老年营养风险指数(GNRI)是评估各种疾病预后的一个因素。本研究旨在探讨 GNRI 在预测 FG 患者死亡率方面的实用性:这项回顾性横断面研究对一家转诊医院 14 年来收治的诊断为 FG 的患者进行了评估。研究了 GNRI 在预测这些患者死亡率方面的作用。为了进一步研究 GNRI 评分与患者预后的关系,我们对福尼尔坏疽严重程度指数(FGSI)和夏尔森合并症指数(CCI)的评分进行了控制。死亡率为 23 例(29.5%)。存活病例的 GNRI 评分明显较高(P < 0.001),白蛋白水平较高(P < 0.001),体重较重(P = 0.04),根据 FGSI 评分计算的死亡风险较低(P < 0.001)。根据 FGSI 评分(p = 0.036),死亡率风险较低;根据 CCI 评分(p = 0.030),合并症较轻的患者,GNRI 与最终预后的关系显著。相反,根据 FGSI 评分(p =0.074)和 CCI 评分(p =0.118)及重度(p =0.215)合并症,死亡率风险较高的患者与 GNRI 评分(OR:1.242,95%CI:1.08,1.41;p =0.001)和 FGSI 评分(OR:54.614,95%CI:6.89,432.31;p <0.001)的关系不显著。GNRI 评分预测 FG 患者死亡率的接收器操作特征曲线下面积为 0.84 (95%CI: 0.75 - 0.93)。在最佳截断点(78.5),GNRI 评分的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为 80%、77.9%、60.6%、90.4%、3.69 和 0.255:我们的研究结果表明,根据 FGSI 评分评估的轻度 FG 患者和根据 CCI 评分评估的低合并症患者中,幸存者的 GNRI 评分明显高于非幸存者。此外,多变量回归分析表明,GNRI 评分是预测患者预后的独立指标。
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Geriatric Nutritional Risk Index in Predicting the Mortality of Fournier's Gangrene: Analysis of 14-Year Statistics of Referral Center.

Introduction: Fournier's gangrene (FG) is a type of necrotizing fasciitis affecting the external genitalia or perineum. The Geriatric Nutritional Risk Index (GNRI) has been reported as a prognostic factor to evaluate the outcomes of various diseases. This study aimed to investigate the utility of GNRI in predicting the mortality of FG patients.

Methods: This retrospective cross-sectional study evaluated the patients admitted to a referral hospital, during 14 years, with diagnosis of FG. The role of GNRI in predicting the mortality of these patients was studied. To further investigate the relationship of the GNRI score with patients' prognosis, we controlled for the scores of Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI).

Result: 78 patients with the mean age of 60.79 ± 13.76 (range: 24 -85) years were included in the study (89.74% male). The mortality rate in this series was 23 (29.5%) cases. The survived cases had significantly higher GNRI score (p < 0.001), higher Albumin level (p < 0.001), higher weight (p = 0.04), and lower mortality risk based on FGSI score (p < 0.001). In patients with low mortality risk according to FGSI score (p = 0.036) and mild comorbidities based on CCI score (p = 0.030), the association between GNRI and final prognosis was significant. In contrast, in patients with high mortality risk according to FGSI score (p =0.074) and moderate (p = 0.118) and severe (p = 0.215) comorbidities by CCI score this association was not significant.The independent predictors of mortality in FG patients were GNRI score (OR: 1.242, 95%CI: 1.08, 1.41; p =0.001) and FGSI score (OR: 54.614, 95%CI: 6.89, 432.31; p < 0.001). The area under the receiver operating characteristic (ROC) curve of GNRI score in predicting the mortality of FG patients was 0.84 (95%CI: 0.75 - 0.93). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of GNRI score at the optimal cut-off point (78.5) were, 80%, 77.9%, 60.6%, 90.4%, 3.69, and 0.255 respectively.

Conclusions: Our findings indicate that among patients with mild FG, as assessed by FGSI score, and those with low comorbidities based on CCI score, the GNRI score in survivors was significantly higher than that in non-survived. Additionally, multivariate regression analysis demonstrated that the GNRI score serves as an independent predictor of patient outcomes.

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来源期刊
Archives of Academic Emergency Medicine
Archives of Academic Emergency Medicine Medicine-Emergency Medicine
CiteScore
8.90
自引率
7.40%
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0
审稿时长
6 weeks
期刊最新文献
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