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

Abstract

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.

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

“…Two studies (11,16) reported the value of GNRI in predicting MACLEs by categorical analysis. A fixed-effect model metaanalysis indicated that the pooled adjusted RR of MACLEs was 2.26 (95% CI 1.54-3.31) for the low vs. high GNRI score, without evidence of significant heterogeneity (I 2 = 0.0%; p = 0.971; Figure 2A).…”

“…A fixed-effect model metaanalysis indicated that the pooled adjusted RR of MACLEs was 2.26 (95% CI 1.54-3.31) for the low vs. high GNRI score, without evidence of significant heterogeneity (I 2 = 0.0%; p = 0.971; Figure 2A). Three studies (12,13,16) reported the value of GNRI in predicting all-cause mortality by categorical analysis. A fixedeffect model meta-analysis indicated that the pooled adjusted RR of all-cause mortality was 2.38 (95% CI 1.71-3.31) for the low vs. high GNRI score, without evidence of significant heterogeneity (I 2 = 0.0%; p = 0.759; Figure 2B).…”

“…Four studies (14)(15)(16)21) reported the value of GNRI in predicting all-cause mortality by continuous analysis. A fixedeffect model meta-analysis indicated that the per-10-units GNRI scores decrease was associated with an increased risk of allcause mortality (RR 1.44; 95% CI 1.32-1.57; I 2 = 0.0%; p = 0.607; Figure 3B).…”

“…Three studies (9,15,16) reported the value of GNRI in predicting amputation by continuous analysis. As shown in Figure 3C, there was no significant heterogeneity between studies (I 2 =44.4%; p = A fixed-effect model meta-analysis showed that the per-10-units GNRI score decrease was not significantly associated with a higher risk of amputation (RR 1.28; 95% CI 1-1.63; p = 0.051).…”

“…Accumulating evidence suggested that low GNRI scores may be linked with adverse outcomes in patients with lower extremity PAD (9)(10)(11)(12)(13). However, conflicting findings existed on the predictive value of GNRI score in these patients (14)(15)(16).…”