Impact of the Geriatric Nutritional Risk Index in Patients Undergoing Transcatheter Aortic Valve Implantation

Koseki, Keita; Yoon, Sung‐Han; Kaewkes, Danon; Koren, Ofir; Patel, Vivek; Kim, Isic; Sharma, Rohan; Sekhon, Navjot; Chakravarty, Tarun; Nakamura, Mamoo; Cheng, Wen; Komuro, Issei; Makkar, Raj

doi:10.1016/j.amjcard.2021.07.016

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…The present data were consistent with previous studies ( 42 , 43 ). Additionally, the therapeutic effect of minimally invasive treatment for patients with severe AS, namely transcatheter aortic valve implantation (TAVI), was affected by the low GNRI score ( 44 ). Likewise, when minimally invasive therapy (TEER) for mitral regurgitation is considered in the future, the low GNRI score may also be a poor prognostic factor, as was the case in this study.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Miura

Murata

Nagai

et al. 2021

Front. Cardiovasc. Med.

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Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR.Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint.Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints.Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.

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Section: Discussionmentioning

confidence: 99%

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Miura

Murata

Nagai

et al. 2021

Front. Cardiovasc. Med.

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“…[38][39][40][41][42] Moreover, the GNRI has also been suggested as a prognostic indicator for surgical patients. [43][44][45] In patients undergoing cardiac surgery, a lower GNRI was independently associated with delayed postoperative rehabilitation, longer ICU and hospital stays, and an increased mortality rate. 27,28,46 However, previous research has not examined the relationship between GNRI and delirium after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that the GNRI can predict the prognosis of cancer patients, patients with heart failure, patients undergoing hemodialysis, and patients with stroke 38–42 . Moreover, the GNRI has also been suggested as a prognostic indicator for surgical patients 43–45 . In patients undergoing cardiac surgery, a lower GNRI was independently associated with delayed postoperative rehabilitation, longer ICU and hospital stays, and an increased mortality rate 27,28,46 .…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

et al. 2023

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AimsThe aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD.MethodsThe data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC‐IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsA total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42–2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05).ConclusionsOur results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single‐center cohort and will need to be validated in future studies involving multiple centers.

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“…The GNRI is used to assess nutritional status in various diseases and has been reported to be associated with adverse events. Low GNRI in heart failure, cancer and other heart disease, such as aortic stenosis has been reported to be associated with a poor prognosis [6][7][8][9][10][11]. Several studies and meta-analyses have reported that low GNRI in ischemic heart disease (IHD) was correlated with increased all-cause death and cardiovascular events [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Cut-off values of geriatric nutritional risk index for cardiovascular events in acute myocardial infarction patients

Ito

Inoue

Nagoshi

et al. 2023

Preprint

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Low Geriatric Nutritional Risk Index (GNRI) in patients with heart failure is associated with poor prognosis. However, the usefulness of GNRI for patients with acute myocardial infarction (AMI) remains controversial. We evaluated the optimal cut-off values of GNRI for cardiovascular events in AMI patients by time-dependent receiver operating characteristic (ROC) analysis to examine its usefulness. We retrospectively investigated the optimal cut-off values for two endpoints of all-cause death and major adverse cardiac events (MACE: all-cause death, non-fatal myocardial infarction, hospitalization for heart failure, stroke) over 48 months in 360 patients with AMI who required emergency admission to our hospital between January 2012 and February 2020. The cumulative incidence of MACE over 48 months was 11.6%. The cut-off value of GNRI for all-cause death was 82.7 (AUC 0.834) at 3 months, 89.3 (AUC 0.861) at 12 months, and 90.3 (AUC 0.854) at 48 months. The cut-off value of GNRI for MACE was 83.0 (AUC 0.841) at 3 months, 95.7 (AUC 0.863) at 12 months, and 95.3 (AUC 0.821) at 48 months. Time-dependent ROC analysis showed that the optimal cut-off value of GNRI varied over time. The optimal cut-off value of GNRI is a useful predictor for prognosis in patients with AMI.

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Impact of the Geriatric Nutritional Risk Index in Patients Undergoing Transcatheter Aortic Valve Implantation

Cited by 8 publications

References 22 publications

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

Cut-off values of geriatric nutritional risk index for cardiovascular events in acute myocardial infarction patients

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