Optimal cut-off value of preprocedural geriatric nutritional risk index for predicting the clinical outcomes of patients undergoing endovascular revascularization for peripheral artery disease

Yamaguchi, Tetsuo; Ueshima, Daisuke; Utsunomiya, Makoto; Matsui, Atsushi; Miyazaki, Toru; Matsumoto, Masaaki; Shimura, Tsukasa; Murata, Naotaka; Komatsu, Yasushi; Tobita, Kazuki; Fujimoto, Yasuyuki; Kodama, Takahide; Suzuki, Kenji; Anzai, Hitoshi; Jujo, Kentaro; Higashitani, Michiaki

doi:10.1016/j.jjcc.2020.05.015

Cited by 8 publications

(5 citation statements)

References 31 publications

(44 reference statements)

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“…Two articles ( 12 , 14 ) from the same population analyzed the outcomes by categorical and continuous GNRI scores. Thus, 8 studies reporting on 9 articles ( 9 , 11 – 16 , 21 , 22 ) were finally included in this meta-analysis ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Details of the study characteristics are described in Table 1 . These studies were published from 2016 to 2021 and performed in Japan ( 11 – 15 , 21 , 22 ), China ( 9 ), Taiwan ( 13 ), and the USA ( 16 ). Four studies ( 11 , 13 , 15 , 21 ) were prospective designs and others were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies ( 16 , 21 , 22 ) reported the value of GNRI in predicting MACLEs by continuous analysis. A fixed-effect model meta-analysis indicated that per 10 units GNRI scores decrease was associated with a higher risk of MACLEs (RR 1.36; 95% CI 1.26–1.46; I 2 = 0.0%; p = 0.962; Figure 3A ).…”

Section: Resultsmentioning

confidence: 99%

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Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis

Liu

Chen

et al. 2022

Front. Nutr.

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BackgroundConflicting results have been reported on the value of the Geriatric Nutritional Risk Index (GNRI) in predicting adverse outcomes in patients with peripheral artery disease (PAD). The objective of this meta-analysis was to evaluate the association of GNRI with adverse outcomes in patients with lower extremity PAD.MethodsRelevant studies were comprehensively searched in PubMed and Embase databases until December 31, 2021. Eligible studies should evaluate the value of GNRI in predicting major adverse cardiovascular and leg events (MACLEs), all-cause mortality, and amputation in patients with lower extremity PAD.ResultsEight studies reporting on 9 articles involving 5,541 patients were included. A fixed-effect model meta-analysis showed that patients with PAD with low GNRI had an increased risk of MACLEs [adjusted risk ratio (RR) 2.26; 95% confidence interval (CI) 1.54–3.31] and all-cause mortality (RR 2.38; 95% CI 1.71–3.31) compared with those with high GNRI. When analysis of GNRI is by continuous data, 10 units of GNRI decrease was associated with 36% and 44% higher risk of MACLEs and all-cause mortality, respectively. However, per 10 units GNRI score decrease was not significantly associated with a higher risk of amputation (p = 0.051).ConclusionLow GNRI may be an independent predictor of adverse outcomes in patients with lower extremity PAD. Routine screening of nutritional status using the GNRI may provide important prognostic information in patients with PAD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis

Liu

Chen

et al. 2022

Front. Nutr.

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“…The largest Japanese study reviewing patients in the Tokyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry found an ROC threshold of 96.2 in a population of 1061 CLTI patients. 30 Interestingly, a second threshold of GNRI ≤ 78.2 marked CLTI patients at the highest risk of major adverse cardiovascular and limb events, while patients with claudication (n = 1185) had a higher threshold of GNRI (≤ 106) at which events occurred. In comparison, we found the median GNRI threshold of 94 to be useful in predicting MALE, mortality, and amputation in our CLTI population.…”

Section: Gnri On Not Only Mortality and Major Amputation In A Primarilymentioning

confidence: 95%

“…It remains unclear whether improvements in nutritional status will halt clinical decline in the CLTI population, or if further optimization of cardiovascular risk factors will help mitigate the insult from frailty. 30 Future studies need to focus on not only the identification of our most vulnerable patients, but ways to optimize their chances of healing and overall survival.…”

Section: Future Directionsmentioning

confidence: 99%

The utility of geriatric nutritional risk index to predict outcomes in chronic limb‐threatening ischemia

Li¹,

Arora²,

Ikeoka³

et al. 2021

Cathet Cardio Intervent

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Objectives: To assess geriatric nutritional risk index (GNRI) in patients with chronic limb-threatening ischemia (CLTI).Background: The prevalence of CLTI continues to rise, with major amputation and mortality remaining prominent. Frailty is a vital risk factor for adverse outcomes in cardiovascular care. The GNRI is a nutrition-based surrogate for frailty that has been utilized in Southeast Asia to predict adverse events in CLTI. It has not yet been evaluated in a primarily Western population, nor in the context of wound healing.Methods: Between 8August 2017 and April 2019, we identified patients undergoing endovascular interventions for CLTI at our institution, categorized into low GNRI (≤ 94, frail) versus normal GNRI (> 94, reference). We analyzed the risks of major adverse limb events (MALE), its individual components [mortality, major amputation, and target vessel revascularization (TVR)], amputation free survival (AFS), and wound healing using Kaplan-Meier and multivariate cox-proportional hazard regression analyses.Results: A total of 255 patients were included in the analysis, with follow up of 14 ± 9.1 months. Lower GNRI was associated with higher cumulative event rates for MALE (71.0% vs. 43.3%, p < 0.001), mortality (34.3% vs. 15.2%, p < 0.001), major amputation (31.2% vs. 15.8%, p = 0.002), and freedom from AFS (56.0% vs. 28.2%, p < 0.001). There was a trend toward lower TVR and higher wound healing with higher GNRI score.Conclusions: Our single-center, retrospective evaluation of GNRI (as a surrogate for frailty) correlated with increased risks of MALE, mortality, and major amputation. Future directions should focus not only on the recognition of these patients, but riskfactor modification to optimize long-term outcomes.

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Prognostic impact of atrial fibrillation on the outcomes of peripheral artery disease according to preoperative symptoms for endovascular revascularization

Hijikata¹,

Yamaguchi

Ueshima

et al. 2022

Heart Vessels

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Optimal cut-off value of preprocedural geriatric nutritional risk index for predicting the clinical outcomes of patients undergoing endovascular revascularization for peripheral artery disease

Cited by 8 publications

References 31 publications

Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis

Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis

The utility of geriatric nutritional risk index to predict outcomes in chronic limb‐threatening ischemia

Prognostic impact of atrial fibrillation on the outcomes of peripheral artery disease according to preoperative symptoms for endovascular revascularization

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