Geriatric Nutritional Risk Index at Hospital Admission or Discharge in Patients with Acute Decompensated Heart Failure

Figures

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  Figure 1. Flowchart of the present study. Patients who were not eligible for the present study were excluded sequentially from the original WET-HF registry.

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  Figure 2. Distribution of GNRI values at hospital admission and discharge. A scatter plot between a-GNRI and d-GNRI with those histograms. Purple line with gray area indicates linear regression line with 95% CI. A blue and red dot indicate a patient with increase and decrease in GNRI during the hospitalization, respectively. While there is strong correlation (R = 0.7) between a-GNRI and d-GNRI, the majority of the patients show decrease in GNRI during the hospitalization.

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  Figure 3. Heatmaps for d-GNRI and ∆GNRI. (A) Complementary relationship between BMI and albumin values at hospital admission in predicting the GNRI value at hospital discharge (d-GNRI). d-GNRI is color-coded from red (the lowest d-GNRI) to blue (the highest d-GNRI). The dashed line indicates a-GNRI = 92, so the area above the line indicates a-GNRI > 92, whereas the area below the line indicates a-GNRI < 92. (B) ∆GNRI from hospital admission to discharge according to the relationship between ∆BMI and ∆albumin. ∆GNRI is color-coded from red (the lowest decrease) to blue (the highest increase). Because of the formula of GNRI, GNRI completely depends on serum albumin if the patient’s BMI exceeds 22 kg/m2 (“body weight/ideal body weight” must be set to 1), and changes in GNRI during hospitalization also depend mainly on albumin rather than BMI.

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  Figure 4. Kaplan–Meier curves for long-term all-cause death according to (A) a-GNRI or (B) d-GNRI. The red and blue area indicate 95% CIs of the corresponding Kaplan–Meier curves. When stratified by a-GNRI or d-GNRI with the cutoff value of 92, a-GNRI < 92 and d-GNRI < 92 groups had a significantly higher all-cause mortality risk up to 4 years than a-GNRI ≥ 92 and d-GNRI ≥ 92 groups, respectively.

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  Figure 5. (A) Restricted cubic spline curves and (B) ROC curves for all-cause death according to a-GNRI or d-GNRI. In Figure (A), the reference (i.e., hazard ratio = 1) is the risk on the cutoff value (92) of a-GNRI and d-GNRI. Although the hazard ratios for all-cause death appears to decrease as either a-GNRI or d-GNRI increase, d-GNRI has a more predictive performance for all-cause death than a-GNRI. In Figure (B), blue, orange, green, dark blue, brown, dark green, and red curves indicate ROC curves of d-GNRI, albumin at discharge, BMI at discharge, delta GNRI, delta albumin, delta BMI, and a-GNRI, respectively. d-GNRI had the best AUC, which was significantly higher than other variables, except for albumin at discharge, which also had a high prognostic value close to that of d-GNRI.