The association between geriatric nutritional risk index and mortality risk of patients after transcatheter aortic valve replacement: a meta-analysis

Malnutrition is common among older adults undergoing transcatheter aortic valve replacement (TAVR) and may adversely affect postoperative survival. The Geriatric Nutritional Risk Index (GNRI), an objective marker of nutritional status, has been proposed as a prognostic tool. However, results from individual studies remain inconsistent. This meta-analysis aimed to clarify the association between pre-procedural GNRI and mortality after TAVR. A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting categorical comparisons of GNRI (low vs. high) and all-cause mortality after TAVR. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models accounting for the influence of heterogeneity. Thirteen cohort studies involving 9,647 patients were included. The pooled analysis demonstrated that low pre-procedural GNRI was significantly associated with increased all-cause mortality after TAVR (HR = 1.90, 95% CI: 1.60–2.26; I 2 = 43%, p < 0.001). A stronger association was observed in prospective studies as compared to retrospective studies ( p for subgroup difference = 0.04). The association remained robust across subgroups stratified by study country, sample size, GNRI cutoffs, analytical models, and follow-up duration. Meta-regression showed no significant influence of age, sex, body mass index, diabetes prevalence, Society of Thoracic Surgeons (STS) score, or follow-up durations on the effect size. In conclusion, lower GNRI prior to TAVR is associated with a higher risk of all-cause mortality, underscoring the prognostic importance of pre-procedural nutritional assessment. GNRI could be considered as a complementary tool for risk stratification in TAVR candidates, while further prospective studies are needed to determine its optimal clinical integration. Systematic review registration The review protocol was prospectively registered in PROSPERO (registration number: CRD420251178097).