The commonly used Nutritional Risk Index is calculated using the usual body weight, but this is a disadvantage in the geriatric population because the usual body weight is often misreported in these patients, he said. The GNRI, proposed in 2005, is a way of assessing malnutrition without using usual body weight; instead, it’s calculated using serum albumin, current body weight, and “ideal weight” according to the Lorentz formula, Haleem explained.
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August 2023
Researchers pulled cases from the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2018, including patients over age 65 but excluding those missing weight, height, and serum albumin data. Those with a GNRI of less than 92 were considered to have severe malnutrition, between 92 and 98, moderate malnutrition, and above 98, normal nutrition.
In the analysis, 29% of patients had severe malnutrition, 17.3% moderate malnutrition, and 53.7% normal nutrition. In the analysis, those with severe malnutrition were more likely to have medical complications. Cumulatively, 69.3% of those severely malnourished had a medical complication, compared to 50.1% of those with moderate malnourishment, and 36.0% of those with normal nutrition (P < 0.001). Researchers found that 46.0% of those with severe malnutrition had cumulative pulmonary complications, compared to 19.0% of those with moderate nutrition, and 15.7% of those with normal nutrition (P < 0.001). Those with severe malnutrition were significantly more likely to get pneumonia and need to be ventilated for more than 48 hours, researchers reported (P = 0.001 and < 0.001, respectively).
“Very clearly, a reduced GNRI of 92 was a consistently significant independent risk factor for multiple different complications for these patients,” Haleem said. “This can be quite useful for clinicians when looking at patients who will undergo a planned tracheostomy—patients and their families can be appropriately counseled,” he said. “In more emergent circumstances of tracheostomies, triaging can be appropriately performed, and patients can be more closely monitored postoperatively to ensure reduction of complications.”
Residency Programs Tweak Student Assessments Following Step 1 Pass/Fail
Most residency programs don’t believe that medical students will be better prepared clinically after the switch of the U.S. Medical Licensing Examination (USMLE) Step 1 to a pass/fail format, and letters of recommendation still ranked highest when evaluating residency applicants before and after the change.
Step 1 is the first of the three-part board exam usually taken after the preclinical years of medical school. Performance had been measured as a score from 1 to 300, but the exam went to a pass/fail format on Jan. 26, 2022. Step 2 Clinical Knowledge, taken after the clinical years of medical school, is still assessed with a three-digit score.