Association Between Geriatric Nutritional Risk Index and Frailty in Older Hospitalized Patients

Figures & data

Table 1 Baseline Characteristics of the Study Participants

Characteristics
Demographic data
Age (years), median (IQR)	84 (79–87)
Male gender, n (%)	527 (71.2)
Living alone, n (%)	31 (4.2)
Married, n (%)	610 (82.4)
Education, n (%)
Illiteracy or primary school	111 (15.0)
Middle school	133 (18.0)
High school or above	496 (67.0)
Alcohol abuse, n (%)	149 (20.1)
Smoker, n (%)	283 (38.2)
Type of admission
Emergency admission, n (%)	97 (13.1)
Primary admission diagnosis
COPD, n (%)	110 (14.9)
Hypertension, n (%)	83 (11.2)
Pneumonia, n (%)	79 (10.7)
Myocardial infarction, n (%)	63 (8.5)
Diabetes mellitus, n (%)	39 (5.3)
Stroke, n (%)	44 (5.9)
Heart failure, n (%)	22 (3.0)
Urinary tract infection, n (%)	15 (2.0)
Chronic renal failure, n (%)	12 (1.6)
Cataract, n (%)	10 (1.4)
Osteoporosis, n (%)	10 (1.4)
Peripheral vascular disease, n (%)	7 (0.9)
Atrial fibrillation, n (%)	6 (0.8)
Arthritis, n (%)	6 (0.8)
Geriatric assessment
Vision impairment, n (%)	243 (32.8)
Hearing impairment, n (%)	229 (30.9)
Cognitive impairment, n (%)	243 (31.6)
Depression, n (%)	134 (18.1)
CCI, median (IQR)	1 (1–2)

Abbreviations: IQR, interquartile range; COPD, chronic obstructive pulmonary disease; CCI, Charlson Comorbidity Index.

Table 2 Characteristics of Participants According to Frailty Status

Characteristic	Robust (n=180)	Pre-Frail (n=288)	Frail (n=272)	P-value^a
Age (years), median (IQR)	81 (76–85)	84 (79–87)^b	85 (82–88)^b	<0.001
Male gender, n (%)	136 (75.6)	201 (69.8)	190 (69.9)	0.335
Living alone, n (%)	6 (3.3)	14 (4.9)	11 (4.0)	0.717
Education, n (%)
Illiteracy or primary school	21 (11.7)	40 (13.9)	50 (18.4)
Middle school	29 (16.1)	45 (15.6)	59 (21.7)	0.036
High school or above	130 (72.2)	203 (70.5)	163 (59.9)
Polypharmacy, n (%)	50 (27.8)	79 (27.4)	140 (51.5)^b	<0.001
Alcohol abuse, n (%)	39 (21.7)	59 (20.5)	51 (18.8)	0.737
Smoker, n (%)	69 (38.3)	100 (34.7)	114 (41.9)	0.216
Vision impairment, n (%)	59 (32.8)	82 (28.5)	102 (37.5)	0.075
Hearing impairment, n (%)	38 (21.1)	82 (28.5)	109 (40.1)^b	<0.001
Cognitive impairment, n (%)	17 (9.4)	52 (18.1)^b	165 (60.7)^b	<0.001
Emergency admission, n (%)	12 (6.7)	21 (7.3)	64 (23.5)^b	<0.001
Depression, n (%)	31 (8.7)	39 (18.8)	64 (36.4)^b	<0.001
CCI, median (IQR)	1 (0–2)	1 (0–2)	2 (1–3)^b	<0.001
GNRI, n (%)
No risk (>98)	119 (66.1)	157 (54.5)	81 (29.8)
Low risk (92–98)	41 (22.8)	84 (29.2)	82 (30.1)	<0.001
Moderate risk (82 to <92)	17 (9.4)	37 (12.8)	75 (27.6)
Major risk (<82)	3 (1.7)	10 (3.5)	34 (12.5)

Notes: ^ap values according to Kruskal–Wallis or Chi-square tests; ^bp < 0.05 when compared with robust patients.

Abbreviations: CCI, Charlson Comorbidity Index; GNRI, geriatric nutritional risk index; IQR, interquartile range.

Table 3 Characteristics of Participants According to the GNRI

Characteristic	No Risk (n=357)	Low Risk (n=207)	Moderate Risk (n=129)	Major Risk (n=47)	P-value^a
Age (years), median (IQR)	83 (77–86)	84 (80–88)^b	85 (81–88)^b	83 (78–87)	<0.001
Male gender, n (%)	249 (69.7)	152 (73.4)	93 (72.1)	33 (70.2)	0.815
Living alone, n (%)	15 (4.2)	9 (4.3)	5 (3.9)	2 (4.3)	0.997
Education, n (%)
Illiteracy or primary school	42 (11.8)	36 (17.4)	26 (20.2)	7 (14.9)
Middle school	57 (16.0)	42 (20.3)	23 (17.8)	11 (23.4)	0.102
High school or above	258 (72.3)	129 (62.3)	80 (62.0)	29 (61.7)
Polypharmacy, n (%)	114 (31.9)	76 (36.7)	58 (45.0)^b	21 (44.7)	0.036
Alcohol abuse, n (%)	72 (20.2)	44 (21.3)	26 (20.2)	7 (14.9)	0.810
Smoker, n (%)	120 (33.6)	91 (44.0)	55 (42.6)	17 (36.2)	0.064
Vision impairment, n (%)	120 (33.6)	64 (30.9.1)	47 (36.4)	12 (25.5)	0.505
Hearing impairment, n (%)	104 (29.1)	64 (30.9)	46 (35.7)	15 (31.9)	0.591
Cognitive impairment, n (%)	78 (21.8)	67 (32.4)^b	61 (47.3)^b	28 (59.6)^b	<0.001
Emergency admission, n (%)	25 (7.0)	24 (11.6)	32 (24.8)^b	16 (34.0)^b	<0.001
Depression, n (%)	31 (8.7)	39 (18.8)^b	42 (32.6)^b	22 (46.8)^b	<0.001
CCI, median (IQR)	1 (0–2)	1 (1–2)	2 (1–3)^b	2 (1–4)^b	<0.001
Frailty status, n (%)
Robust	119 (33.3)	41 (19.8)	17 (13.2)	3 (6.4)
Pre-frail	157 (44.0)	84 (40.6)	37 (28.7)	10 (21.3)	<0.001
Frail	81 (22.7)	82 (39.6)	75 (58.1)	34 (72.3)

Notes: ^ap values according to Kruskal–Wallis or Chi-square tests; ^bp < 0.05 when compared with those patients with GNRI > 98.

Abbreviations: CCI, Charlson Comorbidity Index; GNRI, geriatric nutritional risk index; IQR, interquartile range.

Table 4 Univariate and Multivariable Ordinal Logistic Regression Analyses of Potential Risk Factors for Frailty

Variable	Unadjusted OR (95% CI)	P-value	Adjusted OR (95% CI)^a	P-value	Adjusted OR (95% CI)^b	P-value
Age	1.08 (1.06–1.11)	<0.001	1.03 (1.01–1.06)	0.015	1.03 (1.00–1.06)	0.023
Male	0.84 (0.63–1.13)	0.250	0.76 (0.55–1.07)	0.113	0.75 (0.54–1.05)	0.092
Polypharmacy	2.36 (1.77–3.14)	<0.001	1.04 (0.75–1.45)	0.818	1.02 (0.73–1.41)	0.927
Vision impairment	1.23 (0.93–1.63)	0.155	0.76 (0.55–1.05)	0.096	0.76 (0.55–1.06)	0.102
Hearing impairment	1.94 (1.44–2.60)	<0.001	1.64 (1.16–2.33)	0.005	1.67 (1.18–2.37)	0.004
Cognitive impairment	8.35 (5.95–11.72)	<0.001	3.70 (2.52–5.45)	<0.001	3.65 (2.48–5.37)	<0.001
Depression	20.56 (11.91–35.48)	<0.001	8.36 (4.66–14.99)	<0.001	8.53 (4.76–15.28)	<0.001
CCI	1.30 (1.19–1.41)	<0.001	1.10 (1.00–1.20)	0.043	1.10 (1.00–1.20)	0.05
GNRI scores	0.92 (0.91–0.94)	<0.001	-	-	0.95 (0.93–0.97)	<0.001
GNRI categories
No risk (>98)	Reference		Reference		-	-
Low risk (92–98)	2.12 (1.53–2.92)	<0.001	1.61 (1.14–2.28)	0.007	-	-
Moderate risk (82 to <92)	4.29 (2.88–6.39)	<0.001	2.31 (1.49–3.59)	<0.001	-	-
Severe risk (<82)	8.40 (4.31–16.39)	<0.001	4.02 (1.85–8.77)	<0.001	-	-

Notes: ^aGNRI was modeled as categories variables; ^bGNRI was modeled as continuous variables.

Abbreviations: CCI, Charlson Comorbidity Index; GNRI, geriatric nutritional risk index; OR, odds ratio; CI, confidence interval.

Figure 1 Receiver operating characteristics (ROC) of the GNRI to detect the risk of frailty.