Geriatric nutritional risk index associated to long-term prognosis and length of hospitalization in the contemporary transcatheter aortic valve replacement era

Malnutrition is a common comorbidity in elderly patients with severe aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). The geriatric nutritional risk index (GNRI), a validated and easy-to-use tool, has been previously associated with short/mid-term outcomes in such patients. This study aimed to confirm this association in the long-term in the contemporary TAVR era using new-generation devices and to evaluate its impact on length of hospitalization.

A total of 1090 consecutive patients aged ≥ 65 years undergoing TAVR between October 2015 and December 2021 at a single tertiary center were included. Patients were stratified into two groups based on baseline GNRI: the GNRI > 98 (low-risk) group and the GNRI ≤ 98 (moderate-to-high risk) group. The primary endpoint was all-cause mortality. Secondary endpoints included total length of hospitalization and length of intensive care unit stay. Kaplan-Meier curves and Cox regression models were used to assess survival differences and potential independent predictors.

Patients with GNRI ≤ 98 had significantly higher cumulative mortality rates at all evaluated time points compared to patients with GNRI > 98 (30-day: 6.9% vs. 2.7%, 1-year: 39.1% vs. 11.4%, 5-year: 67.3% vs. 53.2%, all P < 0.05). A multivariable Cox regression analysis showed that GNRI was an independent predictor of long-term mortality (up to five years) after adjusting for clinical, echocardiographic and laboratory parameters (HR = 0.94, 95% CI: 0.92-0.96, P < 0.001), with an increasing effect over time. The impact of GNRI on clinical outcomes was observed in patients in all three EuroSCORE II categories (low risk, intermediate risk, and high risk). Total hospitalization and intensive care unit stays were longer in patients with GNRI ≤ 98 [8 (6-13) days vs. 7 (5-9) days, P < 0.001 and 3 (2-5) days vs. 2 (2-4) days, P < 0.001, respectively].

In this large European cohort, GNRI was confirmed to be an independent predictor for long-term mortality up to five years in the contemporary era of TAVR use with new-generation devices. Hospital stay was longer in patients with lower GNRI. This easy-to-use index could play a valuable role in the preprocedural assessment of patients undergoing TAVR and studies to explore the use of nutritional preprocedural optimization of patients with low GNRI values are warranted.