The potential of geriatric nutritional risk index in predicting the short-term outcome of intravenous thrombolysis in elderly individuals with acute cerebral infarction

doi:10.3969/j.issn.1004-583X.2025.01.003

Abstract

Abstract:

Objective To evaluate the value of Geriatric Nutritional Risk Index (GNRI) in predicting the short-term outcome of elderly patients with acute ischemic stroke (AIS) after intravenous thrombolysis with alteplase. Methods A retrospective study was performed in 773 elderly AIS patients treated with alteplase intravenous thrombolytic therapy from July 2021 to January 2024 at Beichen Hospital in Tianjin, China. GNRI was calculated based on clinical data, and the nutritional status was assessed. Patients were evaluated with a modified Rankin score (mRS), and 575 patients were included in the poor outcome group (mRS score>2) and 198 in the good outcome group (mRS score≤2). They were further classified into the low GNRI (GNRI<92.107, n=388) and high GNRI (GNRI≥92.107, n=385) groups based on the optimal cut-off. The correlation of GNRI with short-term outcome of AIS after alteplase intravenous thrombolytic therapy was analyzed by logistic regression. Results Significantly lower GNRI was detected in the poor outcome group than the good outcome group (90.106[84.622-98.141] vs 90.722[82.239-100.055], P<0.01). Multivariate logistic regression revealed that age, the National Institutes of Health Stroke Scale (NIHSS) score on admission, the Trial Org 10172 in Acute Stroke Treatment (TOAST) classification system of cardioembolism, outcome of bleeding, body mass index (BMI), and low GNRI were independent risk factors for the short-term poor outcome of AIS after alteplase intravenous thrombolytic therapy (P<0.01). The receiver operating characteristic (ROC) curve showed that an area under the curve (AUC) of GNRI predicting the prognosis of intravenous thrombolysis in elderly AIS patients is 0.876(95%CI: 0.845-0.907). Conclusion GNRI, as an independent risk factor for malnutrition and inadequate regression after intravenous thrombolysis in elderly AIS patients, is a promising indicator for assessing immune and nutritional status in this population.

Key words: stroke, geriatric nutritional risk index, thrombolytic therapy, prognosis

CLC Number:

R743

Liu Jinhua, Wang Chunmei, Wang Ying, Chen Kai. The potential of geriatric nutritional risk index in predicting the short-term outcome of intravenous thrombolysis in elderly individuals with acute cerebral infarction[J]. Clinical Focus, 2025, 40(1): 21-28.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2025.01.003

https://huicui.hebmu.edu.cn/EN/Y2025/V40/I1/21

Figures/Tables 5

Tab.1 General information between the two groups

组别	例数	性别[例(%)]				吸烟 [例(%)]		饮酒 [例(%)]		年龄 (年)		BMI (kg/m²)		高血压 [例(%)]
组别	例数	男		女		吸烟 [例(%)]		饮酒 [例(%)]		年龄 (年)		BMI (kg/m²)		高血压 [例(%)]
转归良好组	575	263(45.7)		312(54.3)		127(22.1)		109(19.0)		69.00±8.59		28.06±2.59		486(84.5)
转归不良组	198	86(43.4)		112(56.6)		36(18.2)		37(18.7)		75.14±4.63		25.78±3.62		164(82.8)
$t$ /χ²值		0.316				1.350		2.174		9.570		9.565		0.316
$P$ 值		0.574				0.245		0.337		<0.001		<0.001		0.574
组别	糖尿病 [例(%)]		脑卒中/TIA [例(%)]		冠状动脉疾病 [例(%)]		心房颤动 [例(%)]		SAO [例(%)]		LAA [例(%)]		CE [例(%)]		UND [例(%)]
转归良好组	202(35.1)		109(19.0)		155(27.0)		51(8.9)		222(38.6)		210(36.5)		112(19.5)		31(5.4)
转归不良组	73(36.9)		42(21.2)		57(28.8)		20(10.1)		51(25.8)		92(46.5)		40(20.2)		15(7.6)
χ²值	0.194		0.477		0.248		0.268		11.835
$P$ 值	0.659		0.490		0.618		0.605		0.008

Tab.1 General information between the two groups

组别	例数	性别[例(%)]				吸烟 [例(%)]		饮酒 [例(%)]		年龄 (年)		BMI (kg/m²)		高血压 [例(%)]
组别	例数	男		女		吸烟 [例(%)]		饮酒 [例(%)]		年龄 (年)		BMI (kg/m²)		高血压 [例(%)]
转归良好组	575	263(45.7)		312(54.3)		127(22.1)		109(19.0)		69.00±8.59		28.06±2.59		486(84.5)
转归不良组	198	86(43.4)		112(56.6)		36(18.2)		37(18.7)		75.14±4.63		25.78±3.62		164(82.8)
$t$ /χ²值		0.316				1.350		2.174		9.570		9.565		0.316
$P$ 值		0.574				0.245		0.337		<0.001		<0.001		0.574
组别	糖尿病 [例(%)]		脑卒中/TIA [例(%)]		冠状动脉疾病 [例(%)]		心房颤动 [例(%)]		SAO [例(%)]		LAA [例(%)]		CE [例(%)]		UND [例(%)]
转归良好组	202(35.1)		109(19.0)		155(27.0)		51(8.9)		222(38.6)		210(36.5)		112(19.5)		31(5.4)
转归不良组	73(36.9)		42(21.2)		57(28.8)		20(10.1)		51(25.8)		92(46.5)		40(20.2)		15(7.6)
χ²值	0.194		0.477		0.248		0.268		11.835
$P$ 值	0.659		0.490		0.618		0.605		0.008

Fig.1 Incidence of different malnutrition risks between the two groups

Tab.2 Clinical indicators between the two groups

组别	例数	NIHSS评分 (分)	发病到溶栓时间(h)		出血转化 [例(%)]		白细胞 (10⁹/L)		血红蛋白 (g/L)			尿素氮 (mmol/L)
转归良好组	575	4(2, 7)	3.2(2.4, 3.8)		12(2.1)		7.7(5.8, 7.7)		147.19±23.28			4.065(3.7, 5.53)
转归不良组	198	9(6, 12)	3.7(2.5, 3.9)		34(17.2)		7.7(6.2, 7.7)		142.69±26.19			4.59(3.7, 6.015)
χ²/ $Z$ 值		9.952	3.516		59.882		0.734		2.272			2.426
$P$ 值		<0.001	<0.001		<0.001		0.463		0.023			0.015
组别	淋巴细胞 (10⁹/L)			LDL-C (mmol/L)		白蛋白 (g/L)		肌酐 (μmol/L)		空腹血糖 (mmol/L)	GNRI (分)
转归良好组	2.148(1.898, 2.253)			2.98(2.33, 3.70)		39.4(36.3, 42.7)		51(51, 64)		5.2(4.8, 5.4)	90.722(82.239, 100.055)
转归不良组	2.148(2.067, 2.204)			3.05(2.3, 3.81)		39.9(35.7, 43)		51(51, 62)		5.2(5.2, 5.3)	90.106(84.622, 98.141)
$Z$ 值	1.247			0.648		0.708		1.272		1.384	6.108
$P$ 值	0.212			0.517		0.479		0.203		0.166	<0.001

Tab.2 Clinical indicators between the two groups

组别	例数	NIHSS评分 (分)	发病到溶栓时间(h)		出血转化 [例(%)]		白细胞 (10⁹/L)		血红蛋白 (g/L)			尿素氮 (mmol/L)
转归良好组	575	4(2, 7)	3.2(2.4, 3.8)		12(2.1)		7.7(5.8, 7.7)		147.19±23.28			4.065(3.7, 5.53)
转归不良组	198	9(6, 12)	3.7(2.5, 3.9)		34(17.2)		7.7(6.2, 7.7)		142.69±26.19			4.59(3.7, 6.015)
χ²/ $Z$ 值		9.952	3.516		59.882		0.734		2.272			2.426
$P$ 值		<0.001	<0.001		<0.001		0.463		0.023			0.015
组别	淋巴细胞 (10⁹/L)			LDL-C (mmol/L)		白蛋白 (g/L)		肌酐 (μmol/L)		空腹血糖 (mmol/L)	GNRI (分)
转归良好组	2.148(1.898, 2.253)			2.98(2.33, 3.70)		39.4(36.3, 42.7)		51(51, 64)		5.2(4.8, 5.4)	90.722(82.239, 100.055)
转归不良组	2.148(2.067, 2.204)			3.05(2.3, 3.81)		39.9(35.7, 43)		51(51, 62)		5.2(5.2, 5.3)	90.106(84.622, 98.141)
$Z$ 值	1.247			0.648		0.708		1.272		1.384	6.108
$P$ 值	0.212			0.517		0.479		0.203		0.166	<0.001

Tab.3 Multivariate logistic regression analysis of risk factors for short-term outcomes of intravenous thrombolysis in AIS patients

项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.195	0.018	85.709	<0.001	1.215	1.166	1.266
入院NIHSS评分	0.137	0.023	33.464	<0.001	1.417	1.095	1.202
TOAST病因分型
SAO	-		4.611	0.025	-	-
LAA	0.595	0.650	1.066	0.302	1.814	0.586	5.614
CE	1.214	0.639	4.696	0.030	3.367	1.123	10.096
UND	0.636	0.669	1.144	0.285	1.889	0.589	6.057
出血转化	0.216	0.057	34.831	<0.001	1.241	1.155	1.333
BMI	-2.328	0.048	18.922	<0.001	0.097	0.034	0.278
低GNRI	0.739	0.243	10.181	0.001	2.093	1.330	3.295

Tab.3 Multivariate logistic regression analysis of risk factors for short-term outcomes of intravenous thrombolysis in AIS patients

项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.195	0.018	85.709	<0.001	1.215	1.166	1.266
入院NIHSS评分	0.137	0.023	33.464	<0.001	1.417	1.095	1.202
TOAST病因分型
SAO	-		4.611	0.025	-	-
LAA	0.595	0.650	1.066	0.302	1.814	0.586	5.614
CE	1.214	0.639	4.696	0.030	3.367	1.123	10.096
UND	0.636	0.669	1.144	0.285	1.889	0.589	6.057
出血转化	0.216	0.057	34.831	<0.001	1.241	1.155	1.333
BMI	-2.328	0.048	18.922	<0.001	0.097	0.034	0.278
低GNRI	0.739	0.243	10.181	0.001	2.093	1.330	3.295

Fig.2 ROC curve of GNRI in predicting short-term poor outcomes in elderly AIS patients

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