Work

Comparative predictive value of preoperative GNRI, PNI, and CONUT for postoperative delirium in geriatric abdominal surgery patients admitted to the ICU

Year: 2025

Type: article

Abstract: Background: Postoperative delirium (POD) is a serious complication in geriatric patients admitted to the ICU following abdominal surgery. Malnutrition is a significant modifiable risk factor for POD, yet the comparative predictive value of established nutritional indices-Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT)-remains unclear in this high-risk population. This study aimed to directly compare these indices to identify the optimal preoperative predictor for POD. Methods: This single-center retrospective study analyzed 333 patients (≥65 years) admitted post-abdominal surgery to the ICU (from October 2021 to December 2024). POD was diagnosed using CAM-ICU. A clinical prediction nomogram was developed based on significant predictors from the multivariate model. The discriminative ability of preoperative GNRI, PNI, and CONUT scores was compared using receiver operating characteristic (ROC) curves, DeLong's test for the area under the ROC curve (AUC) differences, along with net reclassification improvement (NRI) and integrated discrimination improvement (IDI) to assess model performance enhancements. Optimal cut-off values were determined by maximizing the Youden index, and corresponding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa statistics were reported. The study was approved by the Institutional Ethics Committee of Jinling Hospital (Approval No. 2024NZKY-038-02). Results: > 0.05). Conclusion: We developed a practical nomogram and identified the CONUT score as a valuable preoperative predictor for POD-both demonstrating comparable predictive utility. The CONUT score outperformed PNI and GNRI by integrating key biomarkers (albumin, cholesterol, lymphocytes) into a single metric. Although its components overlap with the clinical model, CONUT offers high specificity and simplicity, making it an efficient tool for rapid preoperative risk stratification.

Source: Frontiers in Nutrition

DOI: 10.3389/fnut.2025.1669159

Authors: Chulin Chen, Yuanyuan Li, Dandan Zhou, Yang Yang, Li Zhang, Xinying Wang

Institutions: Nanjing General Hospital of Nanjing Military Command, Nanjing University, Bengbu Medical College

Language: English

Topic: Intensive Care Unit Cognitive Disorders

Subfield: Critical Care and Intensive Care Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801