The Impact of Malnutrition Severity on Mortality Risk of Older Adults with Acute Heart Failure: A Geriatric Nutritional Risk Index-Based Assessment
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Backgrounds
Malnutrition is associated with increased risk of all-cause mortality in patients with acute heart failure (AHF). However, the increasing mortality risk associated with the severity of malnutrition in older adults with AHF remained unclear. We aimed to investigate the prognostic impact of malnutrition severity on all-cause mortality of older adults with AHF.
Methods
This single-center study included older adults (aged ≥65) hospitalized for AHF between 2019 and 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 study outcome was all-cause mortality.
Results
We included 214 patients (mean age, 85±8 years; male, 49%). During the median follow-up of 356 days (interquartile range, 66-919 days), 76 deaths were observed. In the patients’ background, worse GNRI was associated with older age, underweight, frailty, and anemia. Multivariable Cox hazard analysis revealed that moderate risk (HR, 2.69; 95%CI, 1.34-5.40; p=0.01) and severe risk (HR, 9.75; 95% CI, 4.30-22.10; p<0.01) were associated with higher 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). A sensitivity analysis with the continuous value of GNRI demonstrated that lower GNRI was associated with higher mortality (HR, 0.92; 95% CI, 0.90-0.95; p<0.01). The association of the GNRI with all-cause mortality was consistent in the subgroup analysis of age ≥85 years, sex, body mass index ≤18.5, frailty, and anemia.
Conclusions
The moderate and severe GNRI risk categories were associated with higher all-cause mortality. Malnutrition severity assessed by the GNRI could be useful in estimating the risk of older adults with AHF, even in the oldest-old (those aged 85 years or older).
