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OBJECTIVES: The prognostic value of hematological markers has not been extensively explored in the geriatric population, particularly in the presence of the frailty phenotype among hospitalized individuals. Therefore, our study aimed to assess the influence of the frailty phenotype in hospitalized geriatric individuals on hematological markers and their impact on short- and long-term outcomes. METHODS: This is a secondary analysis of a prospective cohort study. This study involved hospitalized individuals who were followed during their hospitalization and for nearly 2 years after discharge. At baseline, Fried's frailty phenotype was assessed, as well as hematological markers, including neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, neutrophil-monocyte ratio, platelet-lymphocyte ratio, systemic inflammation index, prognostic nutritional index, geriatric nutritional risk index (GNRI), and C-reactive protein-albumin ratio. The phase angle derived from bioelectrical impedance analysis was likewise considered a prognostic biomarker. Our main outcomes were hospital length of stay and mortality during follow-up. RESULTS: Frailty occurred in 43.2% of the population. Individuals with the frailty phenotype exhibited worse hematological markers and lower phase angle values. Low GNRI and elevated C-reactive protein-albumin ratio values were independently associated with mortality (hazard ratio = 6.88, 95% confidence interval 2.0-23.6; hazard ratio = 2.2, 95% confidence interval 1.1-4.4). Only higher values of the systemic inflammation index were independently associated with prolonged hospital stays. CONCLUSION: Hematological markers may serve as a feasible tool for prognostic assessment. Individuals with the frailty phenotype and low GNRI represented a worst-case scenario. Geriatr Gerontol Int 2024; 24: 312-318.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the performance of controlling nutritional status (CONUT) index, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) scores in predicting the long-term prognosis of patients with non-ST-elevated myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). METHODS: A total of 915 patients with NSTEMI (female: 48.4%; mean age: 73.1±9.0 years) who underwent PCI at Adana Numune Training and Research Hospital, Cardiology Clinic between January 2014 and January 2015 were included in this cross-sectional and retrospective study. CONUT, GNRI, and PNI scores were calculated based on the admission data derived from samples of peripheral venous blood. The mean follow-up duration was 64.5±15.4 months. RESULTS: During follow-up (mean 64.5±15.4 months), 179 patients (19.6%) died. The mean GNRI and PNI scores were significantly lower in the nonsurvivor group; however, the median CONUT score was significantly higher in the nonsurvivor group compared with the survivor group. The receiver operating characteristic (ROC) curve analyses have shown that GNRI score has similar performance to the CONUT score and has better performance than PNI score in predicting 5-year mortality. The Kaplan-Meier curve analysis has shown that patients with lower PNI or GNRI had higher cumulative mortality than the patients with higher PNI or GNRI. Also, the patients with higher CONUT scores had higher cumulative mortality compared with those with lower scores. The multivariate analyses have shown that GNRI (HR: 0.973), PNI (HR: 0.967), CONUT score (HR: 1.527), and body mass index (BMI) (HR: 0.818) were independent predictors of the 5-year mortality in patients with NSTEMI. CONCLUSION: In this study, we have shown that CONUT score, GNRI, and PNI values were associated with the long-term mortality in patients with NSTEMI who underwent PCI, and GNRI yielded similar results to CONUT score but was better than PNI.

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OBJECTIVES: Geriatric nutritional risk index (GNRI) might predict the all-cause mortality in patients with heart failure (HF). We performed a meta-analysis to evaluate the correlation between GNRI and all-cause mortality in patients with HF. METHODS: We searched the PubMed, Medline, Cochrane Library, and Embase databases for clinical trials investigating the association between GNRI and all-cause mortality in patients with HF, having the primary endpoint as all-cause mortality. RESULTS: In total, nine studies involving 7,659 subjects were included in the systematic review and meta-analysis. The results indicated that major risk and moderate risk GNRI (GNRI<92) was associated with an increased risk of all-cause mortality in elderly patients with HF (hazard ratios [HR] 1.59, 95% confidence intervals [CI] 1.37-1.85). Low risk GNRI (GNRI<98) group predicted all-cause mortality in elderly HF patients (HR 1.56, 95%CI 1.12-2.18) when compared with the high GNRI value group. A subgroup analysis indicated that the relationship between GNRI and HF might differ based on the subtype of heart failure. CONCLUSIONS: GNRI is a simple and well-established nutritional assessment tool to predict all-cause mortality in patients with HF.

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Introducción: El índice de riesgo nutricional geriátrico es un instrumento simple y exacto que permite identificar a pacientes hospitalizados con este riesgo. Objetivo: Valorar la prevalencia de riesgo nutricional en pacientes ingresados por presentar una enfermedad vascular. Métodos: Se evaluaron de forma transversal 102 pacientes mayores de 18 años (65 % hombres) ingresados de forma consecutiva entre octubre y diciembre de 2018 en el Instituto Nacional de Angiología y Cirugía Vascular en La Habana Cuba, independientemente de la enfermedad de base y que estuvieran de acuerdo en participar en el estudio. La variable principal de salida fue la proporción de pacientes con riesgo nutricional: riesgo alto (< 82), moderado (82-92), bajo (93-98) y sin riesgo (> 98); las variables secundarias resultaron la edad, el sexo, el índice de masa corporal y la concentración de albúmina. Resultados: El 12,9 por ciento (intervalo de confianza 95 por ciento: 6,2-19,6); el 16,8 por ciento (9,4-24,2) y el 22,8 por ciento (14,5-31,3) de los pacientes presentaron un riesgo nutricional alto, moderado y ligero, respectivamente. Solo el 47,5 por ciento (37,6-57,4), de los pacientes no presentó riesgo nutricional. La edad y el sexo no mostraron correlación con el riesgo nutricional; la concentración de albúmina y el índice de masa corporal y el índice de riesgo nutricional sí se asociaron de forma importante (R2: 0,98 y 0,59, respectivamente). Conclusiones: La prevalencia de pacientes con riesgo nutricional es elevada en el ámbito hospitalario y puede evaluarse por intermedio del índice de riesgo nutricional geriátrico(AU)

Introduction: The Geriatric nutritional risk index is a simple and accurate instrument that allows identifying hospitalized patients with this risk. Objective: To assess the prevalence of nutritional risk in patients admitted for presenting a vascular disease. Methods: There were evaluated in cross-sectional way 102 patients older than 18 years (65% male) admitted consecutively from October to December, 2018 at the National Institute of Angiology and Vascular Surgery in Havana, Cuba, regardless of the underlying disease and who agreed to participate in the study. The main variable was the proportion of patients with nutritional risk: high risk (<82), moderate (82-92), low (93-98) and without risk (>98); secondary variables were age, sex, body mass index and the concentration of albumin. Results: The 12.9 percent (95 percent confidence interval: 6,2-19,6); the 16.8 percent (9,4-24,2) and the 22.8 percent (14,5-31,3) of the patients had high, moderate, and light nutritional risks, respectively. Only 47.5 percent (37,6-57,4) of the patients did not present nutritional risk. The age and sex showed no correlation with the nutritional risk; the concentration of albumin and body mass index and the index of nutritional risk were significantly associated (R2: 0.98 and 0.59, respectively). Conclusions: The prevalence of patients with nutritional risk is high in the hospital scope and it can be evaluated through the geriatric nutritional risk index(AU)

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Se realizó un estudio descriptivo y prospectivo de 11 pacientes con fibrosis quística, atendidos en la consulta integral del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde mayo de 2011 hasta febrero de 2012, para evaluar el estado y el índice de riesgo nutricionales, según el protocolo de evaluación para estos casos, a partir del Consenso de Norteamérica (2005). Se utilizó el método estadístico de comparación de proporciones. La mayoría de los afectados fueron clasificados como desnutridos (63,6 %), todos presentaron riesgo nutricional por bajo peso y 3, desnutrición proteicoenergética severa (27,6 %); también se obtuvo que más de la mitad tuvieron mayor morbilidad e ingresos en el período evaluado. Finalmente, el método de evaluación nutricional fue muy útil para determinar grado y tipo de desnutrición, pues el diagnóstico precoz y la intervención nutricional oportuna mejoran la calidad de vida.

A descriptive and prospective study of 11 patients with cystic fibrosis, assisted in the comprehensive department of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago from Cuba was carried out from May, 2011 to February, 2012, to evaluate the status and the nutritional risk index, according to the evaluation protocol for these cases, from the Consensus of North America (2005). The statistical method for comparison of ratios was used. Most of those affected were classified as undernourished (63.6%), all presented nutritional risk due to underweight and 3 had severe protein energy malnutrition (27.6%); it was also obtained that more than half had higher morbidity and admissions in the evaluated period. Finally, the method of nutritional evaluation was very useful to determine degree and type of malnutrition, because the early diagnosis and the opportune nutritional intervention improve the life quality.

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In 1999 the Mullen and Buzby's formula was adapted, eliminating hypersensitivity skin tests and removing the alfa factor with coefficients similar to the original, obtaining a new formula called adapted Nutritional Prognostic index (aNPI). Objective: To determine the behavior of this new formula and the nutritional risk index with post surgical complications. Methodology: 110 elective patients for surgery were studied by carrying out pre- and post-operational evaluation. Results: the average age was 50 years old; 52 percent showed signs of being overweight or obese; 89,15 percent had normal serum albumin and 60 percent showed a deficit of transferrine; 75ú percent had low risk NPIa and 62,7 percent had a normal NRI. The main surgeries were hysterectomies and cholecystectomies, 92 percent were without complications (p=0,001). It was found a statistically significant relationship between each classification of nutritional index with the presence o absence of complications (p=0.001). When comparing these indexes, the statistical difference is maintained (p= 0.00). The same was observed when comparing the classification ofthis two indexes with complications (p=0.00). When comparing these two indexes, the multiple regression analysis did not show any significant difference with the type of complication, although there was a significant difference with serum albumin levels and the type of surgery. Conclusion: in this study the a NPI and NRI behaved similarly with the majority of variables under study.

En 1999 se adaptó la formula de Mullen y Buzby suprimiendo las pruebas de hipersensibilidad cutánea removiendo el factor alfa con coeficientes similares a la fórmula original, obteniéndose una nueva fórmula denominada índice de Pronóstico Nutricional adaptado (INPa). Objetivo: Determinar el comportamiento de las fórmulas IPNa e IRN, con complicaciones postquirúrgicas. Metodología: Se estudiaron prospectivamente 110 pacientes de cirugías electivas realizando una valoración prequirúrgica y postquirúrgica. Resultados: La edad promedio fue 50 años; 52 por ciento con sobrepeso y obesidad; 89,15 por ciento la albuminemia fue normal, 60 por ciento con déficit de transferrina. El 75,5 por ciento presentaron un IPNa con bajo riesgo, y 62,7 por ciento un IRN normal. Las cirugías predominantes fueron histerectomías y colecistectomías, 92 por ciento sin complicaciones. Se encontró una relación estadísticamente entre la clasificación de cada uno de los índices nutricionales con la presencia o ausencia de complicaciones (p= 0,001). Al comparar estos dos índices, la diferencia estadística se mantiene (p=0,00), sin embargo, el análisis de regresión múltiple no mostró diferencia significativa de éstos índices con el tipo de complicaciones obteniendo significancia con albuminemia y tipo de cirugía. Conclusión: En este estudio el IPNa y el IRN se comportaron de manera semejante en la mayoría de las variables estudiadas.

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