老年营养风险指数预测维持性血液透析患者结局的Meta分析

GNRI can predict the outcomes of maintenance hemodialysis patients—a meta-analysis

目的老年营养风险指数(geriatric nutritional risk index,GNRI)作为常用的营养风险筛查工具,用于评估多种病理条件下的营养状况。本文系统评价GNRI与维持性血液透析患者预后的相关性。方法通过检索web of science、Pubmed、Embase、Cochrane Library和中国知网、万方医学数据库收集相关文章。结局指标为维持性血液透析患者全因死亡率、心血管死亡率及心血管事件。检索的截止日期是2020年11月。通过Review Manager 5.3提取和汇集HR值及其95%CI及其他的相关信息。结果共纳入20项研究,10162名患者。Meta分析结果表明,未设定截断值时,GNRI预测维持性血液透析患者的全因死亡风险结局(HR=0.96,95%CI:0.94-0.98,P<0.001)、心血管死亡率结局(HR=0.94,95%CI:0.91-0.980,P<0.001)有统计学意义,而心血管事件结局(HR=0.96,95%CI:0.86-1.08,P=0.510)无统计学意义。设定截断值后二分类值GNRI与维持性血液透析患者的全因死亡率结局(HR=2.13,95%CI:1.84-2.46,P<0.001)、心血管死亡率(HR=2.00,95%CI:1.04-3.88,P=0.040)有统计学意义。结论GNRI与维持性血液透析患者的全因死亡率、心血管死亡率有关,GNRI可以作为维持性血液透析患者不良结局的预测指标。

Objective As a common nutritional risk screening tool,the Geriatric Nutritional Risk Index(GNRI)has been used to assess nutritional status under various pathological conditions.We evaluated the correlation between GNRI and the prognosis of maintenance hemodialysis patients by a systematic review and meta-analysis.Methods Relevant articles were collected by searching web of science,PubMed,EMBASE,Cochrane Library,CNKI and Wanfang medical database.The outcomes were all-cause mortality,cardiovascular mortality and cardiovascular events in maintenance hemodialysis patients.The deadline for the search was November 2020.Use Review Manager 5.3 to pool hazard ratio(HR)and 95%confidence interval(CI)and other related information.Results A total of 20 studies involving 10162 patients were included.The results of meta-analysis showed that the GNRI(as continuous variable)had statistical significance with all-cause mortality risk and cardiovascular mortality of maintenance hemodialysis patients,but no statistical significance with cardiovascular events(HR=0.96,95%CI:0.94-0.98,P<0.001;HR=0.94,95%CI:0.91-0.98,P<0.001);(HR=0.96,95%CI:0.86-1.08,P=0.510).As a binary variable,GNRI had statistical significance with allcause mortality and cardiovascular mortality in maintenance hemodialysis patients(HR=2.13,95%CI:1.84-2.46,P<0.001)and(HR=2.00,95%CI:1.04-3.88,P=0.040).Conclusion GNRI is related to all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients.GNRI can be used as a predictor of adverse outcomes in maintenance hemodialysis patients.