The Impact of the Geriatric Nutritional Risk Index on Postoperative Cognitive Dysfunction and Complications after Total Hip Arthroplasty Under General Anesthesia: A Retrospective Study
Bibliographic record
Abstract
The Geriatric Nutritional Risk Index (GNRI) is widely used to assess nutritional status. However, its association with postoperative cognitive dysfunction (POCD) and postoperative complications in elderly patients receiving total hip arthroplasty remains inadequately explored. GNRI was calculated based on serum albumin and body weight. POCD was diagnosed using the Z-score method based on cognitive test performance on the seventh postoperative day. Glial fibrillary acidic protein (GFAP) and S100β levels were determined using an enzyme-linked immunosorbent assay. A Receiver Operating Characteristic curve was performed to evaluate the predictive value of GNRI. Multivariate logistic regression was conducted to identify risk factors for POCD in elderly patients undergoing total hip arthroplasty. The POCD group was significantly older, had lower educational attainment, longer surgery duration, greater intraoperative blood loss, and lower preoperative GNRI scores compared to the non-POCD group. Preoperative GNRI demonstrated moderate predictive value for POCD, with an area under curve (AUC) of 0.78. Multivariate logistic regression analysis identified age (odds ratio [OR]: 1.214, 95% confidence interval [CI]: 1.047–1.449), blood loss (OR: 1.198, 95% CI: 1.055–1.493), and anesthesia duration (OR: 1.376, 95% CI: 1.112–1.795) as significant risk factors for POCD, while preoperative GNRI (OR: 0.885, 95% CI: 0.768–0.973) was identified as a protective factor. POCD patients exhibited significantly lower Montreal Cognitive Assessment (MoCA) scores and higher serum S100β and GFAP levels than the non-POCD group. Preoperative GNRI was positively correlated with MoCA scores (r = 0.46, p < 0.001) and negatively correlated with serum S100β (r = −0.43, p < 0.001) and GFAP (r = −0.37, p < 0.001) levels. Higher preoperative GNRI scores were associated with a reduced incidence of postoperative complications, including pulmonary infections and liver dysfunction. Preoperative GNRI serves as an effective predictor of POCD and postoperative complications in elderly patients receiving hip arthroplasty.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".