The Role of Geriatric Nutritional Risk Index in Predicting Adverse Outcomes of Bloodstream Infections: A Retrospective Study

Background: Nutritional deficiencies have been associated with the high prevalence of healthcare-associated infections (HAIs), which is particularly severe in elderly patients. The adverse effects of bloodstream infections (BSIs) in elderly patients are severe when it occurs. The Geriatric Nutritional Risk Index (GNRI), specifically designed for the elderly, itsprediction value of adverse outcomes of BSIs patients is unclear. Methods: We conducted a two-year retrospective study in a large Chinese tertiary hospital, collecting surveillance data on patients with bloodstream infections (BSI). We utilized descriptive analysis to delineate the demographic and clinical characteristics of BSI patients across different GNRI levels. The relationship between GNRI and mortality in BSI patients was investigated using logistic regression and restricted cubic spline (RCS) analysis. Results: From 2020-2021, a total of 464 patients with BSI were identified. Among them, 203 (43.8%) were no risk, 70 (15.1%) at low risk, 118 (25.4%) at moderate risk and 73 (15.7%) at major risk for nutrition-related complications based on the GNRI classification of. Patients whose GNRI at higher risk had longer length of hospital stay (P< 0.001) and higher mortality (P< 0.001). After adjusting for other covariates by multivariate logistic regression analysis, GNRI at major risk (GNRI< 82) [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.52-6.58; P= 0.002] and GNRI at moderate risk (82 to <92) (OR: 1.91; 95% CI: 1.00-3.62; P= 0.049) were associated with increased risk for mortality in patients with BSI, while GNRI score (per unit increase) had a protective effect (OR: 0.96; 95% CI: 0.94-0.98; P= 0.001). Furthermore, the RCS analysis shown that the risk of mortality decreased as GNRI scores increased and gradually became stable at GNRI scores above 96-98. Conclusions: There is an association between GNRI and mortality in patients with BSI. For those patients with a lower GNRI, clinicians need to provide more timely and rational nutritional intervention to reduce mortality.