Geriatric Nutritional Risk Index and in-hospital adverse events in patients with ST-segment elevation myocardial infarction
Öz
Purpose: Malnutrition and inflammation are common in ST-segment elevation myocardial infarction and may influence early vulnerability. We evaluated whether the admission Geriatric Nutritional Risk Index is associated with in-hospital adverse events, and compared it with the Prognostic Nutritional Index and the Controlling Nutritional Status score.
Materials and Methods: This retrospective observational study included 748 consecutive adults with the infarction treated between January 2024 and December 2025. The nutritional index was calculated from admission albumin, weight, height, and sex. The primary endpoint was a composite of in-hospital ventricular tachycardia or fibrillation, intubation, death, contrast-associated acute kidney injury, cardiogenic shock, intra-aortic balloon pump, or cardiopulmonary resuscitation; a prespecified nonrenal composite was a sensitivity endpoint. The index was modeled continuously per 10-point lower value with logistic regression and bootstrap internal validation.
Results: The primary endpoint occurred in 141 of 748 patients (18.9%). Median GNRI was 98.3 (interquartile range, 95.3–102.0). Each 10-point lower GNRI was associated with the primary endpoint before adjustment (odds ratio 1.61, 95% confidence interval 1.13–2.28) and after demographic and comorbidity adjustment (1.57, 1.10–2.23). The association was attenuated after additional adjustment for acute severity (0.99, 0.66–1.49), with a similar pattern for the nonrenal composite. The areas under the receiver-operating characteristic curve were 0.579 for GNRI, 0.564 for CONUT, and 0.457 for PNI.
Conclusion: A lower admission index was associated with a higher risk of in-hospital mortality; however, this association was attenuated after accounting for acute illness severity. As a simple and readily available nutritional marker at admission, the index should be used as an indicator of overall frailty rather than as a standalone decision-making tool.
Anahtar Kelimeler
Geriatric Nutritional Risk Index, in-hospital mortality, malnutrition, nutrition assessment, ST elevation myocardial infarction
Destekleyen Kurum
None
Etik Beyan
The study was conducted in accordance with the ethical standards of the institutional and national research committee and with the Declaration of Helsinki. The study was approved by the Institutional Review Board (approval number: 1439, 25 June 2026). Given the retrospective design, the requirement for written informed consent was waived.
Teşekkür
None
Kaynakça
- Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720-826.
- Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40:237-69.
- Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T et al. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38:1-9.
- Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777-83.
- Kunimura A, Ishii H, Uetani T, Aoki T, Harada K, Hirayama K et al. Impact of Geriatric Nutritional Risk Index on cardiovascular outcomes in patients with stable coronary artery disease. J Cardiol. 2017;69:383-8.
- Fan Y, Hao X, Gao L, Liu Q, Zhang Z. Predictive value of Geriatric Nutritional Risk Index in patients with coronary artery disease: a meta-analysis. Front Nutr. 2021;8:736884.
- Czinege M, Halatiu VB, Nyulas V, Cojocariu LO, Ion B, Masca V et al. Nutritional status and recurrent major cardiovascular events following acute myocardial infarction - a follow-up study in a primary percutaneous coronary intervention center. Nutrients. 2024;16:1088.
- Zhao Q, Zhang TY, Cheng YJ, Ma Y, Xu YK, Yang JQ et al. Impacts of geriatric nutritional risk index on prognosis of patients with non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China. Nutr Metab Cardiovasc Dis. 2020;30:1685-96.
- Xia S, Liu D, Liu Y, Zhang X, Zhang X. Predictive value of GNRI and TyG index for poor prognosis in NSTE-ACS patients post-PCI. Asia Pac J Clin Nutr. 2025;34:440-50.
- Zhang D, Tang M, Tang N, Earnest BSP, Ali Abdou IEM. Impact of geriatric nutritional risk index on clinical outcomes in acute coronary syndrome patients: a comprehensive meta-analysis. Coron Artery Dis. 2025;36:e33-44.
