Critical illness complicates acute pancreatitis (AP) with acute malnutrition, which increases mortality. The Geriatric Nutritional Risk Index (GNRI) integrates serum albumin and body weight, but its short-term, intermediate-term, and long-term mortality prognostic value in AP admitted to the ICU remains unclear. A retrospective cohort study including 430 adults with a first ICU admission for AP. The primary outcome was 28-day all-cause mortality; secondary outcomes were 90- and 360-day mortality. Multivariable Cox regression, restricted cubic splines (RCS) and Kaplan–Meier analyses were used to assess linear and non-linear associations; effect modification was examined in prespecified subgroups. Median GNRI was 83.4. Each 1-unit increment reduced 28-day mortality by 6% (HR 0.94, 95% CI 0.91–0.97, P = 0.001) with similar effect sizes at 90 and 360 days. RCS revealed a J-shaped curve with a nadir at ≈ 86.8: below this threshold each unit decrease increased risk by 10.4%, whereas above its risk rose by 24.2%. The high-GNRI group had a 62% lower 28-day mortality than the low-GNRI group (HR 0.38, 95% CI 0.21–0.70, P = 0.002). Survival curves remained significantly separated (log-rank P = 0.0018). Subgroup analyses showed stronger protection in males and patients < 60 years (P-interaction < 0.05). GNRI is a rapid, objective and non-linear predictor of short-term, intermediate-term, and long-term mortality in critically ill AP. The J-shaped association supports early nutritional inflammatory risk stratification. Further prospective studies should assess the utility of the GNRI to guide nutritional support interventions in this patient population.
Wang et al. (Tue,) studied this question.
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