The geriatric nutritional risk index predicts short-term mortality in older patients with urosepsis: a retrospective...

Urosepsis, a severe complication of urinary tract infection, is associated with high mortality, especially in older adults. The Geriatric Nutritional Risk Index (GNRI) is a simple nutritional assessment tool, but its prognostic value specifically in urosepsis remains underexplored.

This retrospective cohort study included 1,218 patients aged ≥65 years with urosepsis from the MIMIC-IV database (derivation cohort) and 178 patients from an external hospital (validation cohort). Nutritional risk was categorized using GNRI. Cox proportional hazards models were used to assess the association between GNRI and 28-day ICU/in-hospital mortality. The incremental predictive value of GNRI added to established severity scores was evaluated using ROC analysis.

A total of 1,218 urosepsis patients were included. The 28-day ICU mortality and in-hospital mortality rates were 18.7 and 17.2%. After multivariable adjustment, lower GNRI was independently associated with increased 28-day ICU mortality (adjusted HR = 0.96, 95% CI: 0.94-0.98, p < 0.001) and in-hospital mortality (adjusted HR = 0.96, 95% CI: 0.94-0.98, p < 0.001). Patients in the high GNRI-risk group had significantly higher mortality compared to the no-risk group (ICU mortality: adjusted HR = 2.34, 95% CI: 1.07-5.11, p = 0.034; in-hospital mortality: adjusted HR = 2.63, 95% CI: 1.05-6.58, p = 0.039). Adding GNRI significantly improved the predictive accuracy of all six severity scores (e.g., SOFA AUC increased from 0.625 to 0.709, p < 0.001). Subgroup analyses showed consistent trends across most demographics and comorbidities. These findings were validated in the external cohort, where a higher GNRI remained protective against 28-day mortality (adjusted HR = 0.95, 95% CI: 0.91-1.00, p = 0.033).

GNRI is an independent predictor of short-term mortality in older patients with urosepsis and enhances the prognostic accuracy of existing severity scores. Early nutritional assessment and intervention may improve outcomes in this high-risk population.