The impact of malnutrition severity on mortality risk in super-elderly patients with acute heart failure: a Geriatric Nutritional Risk Index-based assessment

Abstract Background Malnutrition is common and is associated with poor outcomes in elderly patients with acute heart failure (AHF). However, the increasing risk associated with the severity of malnutrition has been unclear. Purpose To investigate the impact of malnutrition severity on the prognosis of elderly patients with AHF. Methods This single-center study included elderly (aged ≥65) patients hospitalized for AHF during 2019-2023. We used the Geriatric Nutritional Risk Index (GNRI) as a proxy for nutritional status, dividing patients into the normal (GNRI>98, n=64), mild risk (GNRI 92-98, n=54), moderate risk (GNRI 82-<92, n=66), and severe risk (GNRI<82, n=30) groups. The primary outcome was all-cause mortality. We calculated the hazard ratio (HR) of GNRI for all-cause mortality using Cox hazard analysis with adjustment for age, sex, hypertension, diabetes, dyslipidemia, reduced renal function, and NYHA class. Results The study included 214 patients (mean age, 85±8 years; male, 49%). Lower GNRI was associated with older age, lower BMI, higher Clinical Frailty Scale, and lower hemoglobin levels. During the median follow-up of 356 days (interquartile range, 66-919 days), 76 deaths were observed. Multivariable analysis revealed that moderate GNRI risk (HR, 2.69; 95%CI, 1.34-5.40; p=0.01) and severe GNRI risk (HR, 9.75; 95%CI, 4.30-22.10; p<0.01) were associated with higher all-cause mortality compared with normal GNRI, in addition to aging (HR per 1 year increase, 1.07; 95%CI, 1.03-1.11; p<0.01). In contrast, mild GNRI risk was not significantly different in terms of all-cause mortality compared with normal GNRI. Sensitivity analysis showed that lower GNRI was independently associated with higher all-cause mortality (HR per 1 GNRI increase, 0.92; 95%CI, 0.90-0.95; p<0.01). The association of GNRI with all-cause mortality was consistent in the subgroup analysis of age≥85, sex, BMI≤18.5, frailty, and anemia. Conclusions Moderate to severe GNRI risk and lower GNRI were associated with all-cause mortality in elderly patients with AHF. Nutritional assessment using GNRI could be useful in estimating the risk of super-elderly patients with AHF.Figure