What question did this study set out to answer?

To investigate the predictive value of GNRI on long-term outcomes in older adults following hip fracture surgery.

April 12, 2026Open Access

The association between the geriatric nutritional risk index (GNRI) and postoperative outcomes after hip fracture in older adults: a prospective cohort study

Key Points

To investigate the predictive value of GNRI on long-term outcomes in older adults following hip fracture surgery.
Enrolled patients aged ≥ 65 years who underwent hip fracture surgery.
Categorized GNRI into quartiles for analysis.
Utilized Cox proportional hazards model to assess mortality risk.
Performed multiple logistic regression to evaluate recovery of pre-fracture mobility.
Assessed associations between GNRI and EQ-5D utility scores using multiple linear regression.
Patients in higher GNRI quartiles had significantly lower mortality risks compared to the lowest quartile.
Higher GNRI was associated with increased chances of recovery at both 1-year and 3-year follow-ups.
Higher GNRI scores were positively linked to improved quality of life as per EQ-5D assessments at all follow-ups.

Abstract

The GNRI is an objective nutritional status screening tool. This study aimed to investigate the prognostic value of GNRI in predicting long-term outcomes of geriatric hip fracture patients. We prospectively enrolled patients aged ≥ 65 years who underwent hip fracture surgery between November 2018 and November 2019. Admission GNRI was categorized into quartiles (Q1 ≤ 96, Q2 96–101, Q3 101–104, Q4 > 104). Patients were followed up at 30 days, 120 days, 1 year and 3 years postoperatively. Cox proportional hazards model and ROC curve were performed to evaluate mortality risk; multiple logistic regression identified the value for recovery of pre-fracture mobility. Multiple linear regression and generalized estimating equations assessed associations between GNRI and EQ-5D utility scores. Of the 1092 patients, 947 were eligible for the research. The ROC of GNRI for predicting mortality was set. (AUC 0.726, 95% CI 0.687–0.766) Patients in Q2, Q3 and Q4 had significantly lower mortality risks (HRs 0.68, 95% CI 0.48–0.97; 0.47, 95% CI 0.31–0.72; and 0.23, 95% CI 0.13–0.42, respectively) comparing to Q1. Even after applying propensity score matching (PSM), individuals with higher GNRI still remained lower mortality risk. (HRs 0.56, 95% CI 0.34–0.91 and 0.55, 95% CI 0.36–0.85) Compared to Q1, patients in Q4 had a significantly increased possibility of achieving recovery at 1-year (OR 1.71, 95% CI 1.03–2.83, P = 0.037) and 3-year (OR 1.77, 95% CI 1.02–3.07, P = 0.042) follow-up. Admission GNRI was positively associated with EQ-5D utility scores at all follow-ups’ assessments (all P < 0.001), patients with higher GNRI exhibited better quality of life. The GNRI upon admission is potentially a reliable and independent prognostic indicator of long-term mortality, functional status and quality of life in Chinese geriatric hip fracture patients. This study was prospectively registered at ClinicalTrials.gov (Identifier: NCT03184896, Registration Date (First Posted): 2017-06-14) prior to the enrollment of participants.

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