Correlation between geriatric nutritional risk index and in-hospital mortality in elderly patients with chronic heart failure

To investigate the correlation between malnutrition, assessed by the geriatric nutritional risk index (GNRI), and the risk of in-hospital mortality in elderly patients with chronic heart failure (CHF).

A retrospective analysis was conducted of clinical data from 4466 elderly CHF patients admitted to the department of cardiology, the First Medical Center, PLA General Hospital, between February 2008 and December 2019. Based on height, weight, and serum albumin levels on admission, GNRI was calculated, and patients were divided into four groups: normal nutrition (GNRI>98), mild malnutrition (92≤GNRI≤98), moderate malnutrition (82≤GNRI<92), and severe malnutrition (GNRI<82). Data were analyzed using EmpowerStats (version 4.1) and R (version 4.4.2) software. Between-group comparisons were performed using One-way ANOVA, Kruskal-Wallis test, or Chi-square test, as appropriate. Logistic regression analyses were used to examine the correlation between GNRI and hospital mortality. Smooth curve fitting models were employed to explore the nonlinear relationship between GNRI and mortality.

The mean GNRI of 4466 elderly CHF patients was 102.29 ± 10.87. Malnutrition was present in 1504 patients (33.68%), including 718 (16.08%) with mild, 633 (14.17%) with moderate, and 153 (3.43%) with severe malnutrition. The in-hospital mortality rates in the normal-nutrition group, mild malnutrition group, moderate malnutrition group and severe malnutrition group were 1.42%, 2.79%, 5.06% and 12.42%, respectively, and the difference was statistically significant (P<0.001). Multivariate logistic regression analysis identified age, New York Heart Association (NYHA) class ≥ Ⅲ, GNRI, C-reactive protein (CRP) ≥ 0.8 mg/dl, and troponin T (TnT) > 0.2 ng/ml as independent predictors of in-hospital mortality (all P<0.05). A generalized additive model revealed a nonlinear relationship between GNRI and mortality risk (P=0.004). Subgroup analyses showed that the association between malnutrition and in-hospital mortality was statistically significant in patients aged 70–80 years, males, those with NYHA class ≥ Ⅲ, those with CRP < 0.8 mg/dl, and those with coexisting hypertension (all P<0.05).

Malnutrition is common in elderly CHF patients. GNRI is an independent predictor of in-hospital mortality and exhibits a nonlinear relationship with mortality risk, with a greater pronounced predictive value in specific subgroups of elderly CHF patients.