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

Abstract

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.

Poor prognosis after lower‐limb amputation irrespective of diabetes status in patients undergoing hemodialysis

“…In addition to this policy, the significance of PAD in patient survival has prompted our facility to identify patients with PAD using skin perfusion pressure in high-risk populations, such as patients with diabetes. Nutritional status is also associated with PAD, and improving malnutrition is needed to prevent PAD development [39,40]. Furthermore, intradialytic hypotension is associated with CLI, emphasizing the importance of optimizing dialysis conditions and patient education [41,42].…”