Prognostic value of the geriatric nutritional risk index in hospitalized heart failure patients

Abstract Background The Geriatric Nutritional Risk Index (GNRI) has been proposed as a prognostic marker in various patient populations, including those with heart failure (HF). Purpose This study aims to investigate the association between GNRI and poor prognosis in patients hospitalized for HF. Methods Six-hundred-twenty-eight consecutive patients hospitalized for HF between March 2014 and February 2025 were enrolled. Of these, 578 cases were assessed for survival analysis, excluding 50 cases due to missing data. GNRI was categorized into four groups based on GNRI cutoff values, with major risk of malnutrition-related morbidity and mortality corresponding to GNRI 82, moderate risk as GNRI 82-91, low risk as GNRI 92-98, and no risk as GNRI 98. A Cox proportional hazards model and an accelerated failure time (AFT) model with a log-logistic distribution were used to assess associations between GNRI and mortality. Kaplan-Meier survival analyses were performed to compare survival probabilities across GNRI categories. Additional analyses were conducted to assess the risk increase between the major GNRI risk category and all other categories, as well as the stepwise increase in mortality risk across GNRI groups. Results Among 578 patients, 350 (55.7%) died, while 228 (36.3%) were censored. The median follow-up time was 2.7 years (interquartile range 0.96-5.60), 398 (68.0%) were male, and mean age was 74.0 (±12.3) years. Patients categorized as having major risk GNRI (n=37) had a significantly higher hazard of mortality compared to those without major risk (HR 2.46; 95%CI 1.58-3.83; p0.001) after adjusting for age, sex, systolic blood pressure, diabetes, smoking, log-transformed BNP, and glomerular filtration rate, with a trend towards increased hazard of mortality in moderate risk GNRI patients (Table 1). The AFT model confirmed these findings, with a time ratio of 0.78 (95% CI 0.60-0.90, p=0.002), indicating that patients in the major risk GNRI category had a 22% shorter survival time compared to those in the other categories. Kaplan-Meier survival curves demonstrated a significantly lower survival probability in the major risk group compared to other GNRI categories (Figure 1). Conclusions GNRI is associated with higher risk of mortality in hospitalized HF patients, with those in the major risk category experiencing significantly worse survival outcomes. These findings highlight the importance of nutritional assessment in HF patients and suggest that GNRI could be a valuable tool for risk stratification in this population.Figure 1.