Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

Abstract

In patients with heart failure (HF), the impact of the Geriatric Nutritional Risk Index (GNRI) on in-hospital mortality and length of hospital stay remains unclear. We aimed to identify the factors associated with increased in-hospital mortality and longer length of hospital stay considering the GNRI in acute decompensated HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Patients with acute decompensated HF who were admitted to our institution between 2007 and 2011 were investigated. A total of 451 (201, HFrEF; 250, HFpEF) patients were divided into the following: patients with GNRI < 92 and ≥92. In HFrEF, there were no significant differences in in-hospital mortality and length of hospital stay between patients with GNRI < 92 and ≥92 (median (interquartile range), 24.0 (23.8) days and 20.0 (15.0) days, respectively, p = 0.32). In HFpEF, despite no differences in in-hospital mortality, patients with GNRI < 92 had significantly longer length of hospital stay than those with GNRI ≥ 92 (median (interquartile range), 20.0 (22.3) days and 17.0 (16.0) days, respectively, p = 0.04). In HFpEF, GNRI < 92, along with lower hemoglobin, higher B-type natriuretic peptide, and elevated C-reactive protein levels, were the independent factors for longer length of hospital stay. Among patients with acute decompensated HF, assessment of nutritional status with GNRI is useful for stratifying patients at high risk for longer length of hospital stay in HFpEF but not in HFrEF. These observations are particularly important when considering the increasing elderly population and prevalence of HFpEF.

Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up

“…There are studies showing no significant differences in in-hospital mortality and the length of hospital stay between patients with GNRI <92 and ≥92, among HFrEF patients with acute decompensated HF [34]. The above results indicate the assessment of nutritional status with GNRI as useful for stratifying patients at high risk for longer length hospital stays in HFpEF but not in HFrEF [34].…”

“…There are studies showing no significant differences in in-hospital mortality and the length of hospital stay between patients with GNRI <92 and ≥92, among HFrEF patients with acute decompensated HF [34]. The above results indicate the assessment of nutritional status with GNRI as useful for stratifying patients at high risk for longer length hospital stays in HFpEF but not in HFrEF [34]. In our study the assessment of nutritional status with the use of the MNA form demonstrated that nutritionally sound patients were hospitalized for shorter periods of time than those at the risk of malnutrition and the malnourished, analyzed together (8.4 days vs. 5.4 days; respectively).…”

Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure

“…To illustrate the usefulness of TCBI, a comparison between other indicators proven valuable for predicting long-term outcomes and TCBI is warranted. In general, malnutrition assessed by GNRI has been reported to be associated with increased cancer mortality in patients with malignancy [9,10], and our group previously reported that the nutritional status based on GNRI was useful for stratifying ADHF patients who was at risk for prolonged hospital stay in association with HF with preserved ejection fraction [11]. However, the importance of TCBI in patients with ADHF remains to be elucidated.…”

Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review

“…Geriatric nutritional risk index (GNRI), which is based only on body weight, height, and serum albumin level, has been recently demonstrated as a very simple and objective tool to assess nutritional status in various pathological conditions [7,8]. Until now, several studies have examined the credibility of GNRI in assessing malnutrition and predicting all-cause mortality and cardiovascular (CV) events in patients on chronic hemodialysis [2,[8][9][10][11][12][13][14][15][16], peritoneal dialysis (PD) [17][18][19], non-dialysis-dependent (NDD) chronic kidney disease (CKD) [20,21], stroke [22][23][24][25], and heart failure [26][27][28].…”