Prognostic Nutritional Index is a Superior Predictor to Geriatric Nutritional Risk Index for 1-Year Mortality in...

This prospective multicenter cohort study aimed to compare the predictive accuracy of the Prognostic Nutritional Index (PNI) and the Geriatric Nutritional Risk Index (GNRI) for 1 year mortality in older adult patients undergoing proximal femoral fracture surgery. We analyzed the data from 252 patients aged ≥ 65 years who underwent surgery. Patients were classified based on their preoperative PNI (cutoff, 40) and GNRI (cutoff, 98). To minimize confounding, 1:1 propensity score matching (PSM) was performed for each index, adjusting for age, sex, body mass index, comorbidities, and inflammatory markers. Survival rates were estimated using the Kaplan-Meier method and compared using the log-rank test. The overall 1 year mortality rate was 14.7%. After PSM, the low PNI group exhibited a significantly higher mortality rate than the control group (18.9% vs. 3.3%, p < 0.01). Similarly, the low GNRI group had a significantly higher mortality rate than the control group (14.1% vs. 4.2%, p = 0.04). Cox proportional hazards analysis confirmed that both indices were independent predictors of 1 year mortality. Notably, the low-PNI group was significantly younger than the control group yet demonstrated higher mortality. Preoperative PNI and GNRI were associated with 1 year mortality in older adult patients with proximal femoral fractures and remained independent prognostic indicators after adjustment for confounders. These findings suggest that PNI and GNRI may serve as supplementary prognostic markers beyond chronological age and could provide additional information to support multidisciplinary perioperative assessment and shared clinical decision-making in this vulnerable population.