Prognostic value of Geriatric Nutritional Risk Index and systemic immune-inflammatory index in elderly patients with...

Area of Science:

• Cardiology
• Geriatrics
• Biomarkers

Background:

• Acute coronary syndrome (ACS) in the elderly is associated with a high risk of major adverse cardiovascular events (MACE).
• Accurate risk stratification is crucial for guiding treatment and improving outcomes in these patients.
• Existing risk scores may not fully capture the complex interplay of factors contributing to MACE in older adults.

Purpose of the Study:

• To evaluate the predictive value of the Geriatric Nutritional Risk Index (GNRI) combined with the Systemic Immunoinflammatory Index (SII) for MACE risk.
• To develop and validate a novel clinical prediction model for MACE in elderly ACS patients.
• To compare the performance of the new model against the established GRACE score.

Main Methods:

• Retrospective review of 1202 elderly patients with ACS, divided into MACE and non-MACE groups.
• Analysis included sensitivity analysis with machine learning, restricted cubic spline approach for nonlinear relationships, and model construction using GNRI, SII, and Age.
• Model validation involved comparison with the GRACE score using subject work and recall curves, Integrated Discriminant Improvement Index (IDI), and Net Reclassification Index (NRI).

Main Results:

• Lower GNRI and higher SII were significantly associated with increased MACE risk (P < 0.001).
• The novel prediction model demonstrated superior performance with an Area Under the Curve (AUC) of 0.778 compared to the GRACE score's AUC of 0.744.
• The new model showed significant improvements in reclassification metrics (NRI = 0.5569, IDI = 0.0571, P < 0.001).

Conclusions:

• The combined GNRI and SII model is a simple, cost-effective, and valuable tool for predicting 1-year MACE risk in elderly ACS patients.
• This novel prediction model shows better accuracy and clinical utility than the GRACE score in the studied population.
• Integrating nutritional and inflammatory markers offers a promising approach for enhanced cardiovascular risk assessment in geriatric populations.