Geriatric Nutritional Risk Index at Hospital Discharge Is a Useful Predictor of Adverse Outcome in Hospitalized Patients with Heart Failure

Background: Geriatric Nutritional Risk Index (GNRI) is known as simple nutritional evaluation tool for elderly patients. Past reports revealed lower GNRI on admission associates with higher mortality rate in hospitalized patients with heart failure (HF). On the other hand, GNRI at hospital discharge(dGNRI) had not been evaluated sufficiently. Methods: We retrospectively analyzed using database of the West Tokyo Heart Failure (WET-HF) Registry. We excluded the patients whose GNRI were not available. All-cause mortality rate was compared between 2 groups: lower GNRI (<92) with moderate or severe nutritional risk; and higher GNRI (>=92) with no or low nutritional risk. Results: Total 1077 patients (mean age, 72.9 years; 58% male) were analyzed. The absolute value of dGNRI was 92.3 ± 12.8, and total 536 (50%) patients had lower GNRI at discharge. Among lower dGNRI patients, 253 (33%) patients had higher GNRI on admission. During the follow-up period of 678 ± 539days, 217 (20%) patients died, 329 (31%) patients were re-hospitalized with HF. Kaplan-Meier curves and the log-rank test demonstrated the incidence of all-cause mortality was significantly higher in patients with lower dGNRI. At the multivariable Cox regression analysis, lower dGNRI was independently associated with higher mortality risk (HR: 2.22[1.54–3.26], and P < .0001) but not associated with HF re-hospitalization (P = .51). Conclusion: Lower GNRI at discharge is an independent predictor of all-cause mortality in HF patients.