The relationship between geriatric nutritional risk index and prognosis in acute heart failure

Malnutrition is prevalent in heart failure and is associated with poor prognosis. The Geriatric Nutritional Risk Index (GNRI) is an accessible nutritional assessment tool, but its prognostic value in acute heart failure (AHF) remains unclear.

This study included 4314 eligible AHF patients from a nationwide prospective cohort in China. Baseline nutritional status was assessed using GNRI. Cox regression models were employed to estimate the association between GNRI and adverse outcomes. Harrell's concordance index (C-index) was utilized to assess GNRI's incremental prognostic value for mortality. Malnutrition defined as GNRI≤98, compared with GNRI >98, was associated with increased risks of all-cause mortality (ACM) (Hazard ratio [HR] 1.48, 95 % confidence interval [CI] 1.34-1.63), cardiovascular mortality (CVM) (HR 1.42, 95 % CI 1.26-1.60), 1-year major adverse cardiovascular events (HR 1.25, 95 % CI 1.10-1.42), and 1-month hospitalization for heart failure (HR 1.32, 95 % CI 1.04-1.67). As a continuous variable, GNRI demonstrated an inverse linear association with mortality risk, consistent across left ventricular ejection fraction, gender, and estimated glomerular filtration rate levels. Adding GNRI to the multivariate model improved its predictive accuracy for ACM (C-index 0.700 vs. 0.692) and CVM (C-index 0.711 vs. 0.706), providing superior incremental prognostic value versus body mass index or serum albumin alone.

Lower GNRI increased the risks of adverse outcomes in AHF patients and provided superior additional prognostic value for mortality prediction compared with body mass index or serum albumin alone. Given its easy accessibility, GNRI should be integrated in AHF risk stratification.