Prevalence and Prognostic Significance of Malnutrition Assessed by Two Scoring Systems in Hospitalised Elderly Patients with Chronic Heart Failure.

BACKGROUND

Malnutrition is common yet underrecognised in elderly patients (≥65 years) with chronic heart failure (CHF) and may accelerate disease progression through cytokine activation, autonomic dysfunction and cachexia. Early identification may improve risk stratification, but standardised diagnostic criteria are lacking. Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) and soluble urokinase plasminogen activator receptor (suPAR) may influence both the presence and prognostic implications of malnutrition, but their interaction with nutritional indices remains poorly understood. This study examined the prevalence and prognostic significance of malnutrition using Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI).

METHODS

From 10,027 consecutive admissions, 597 elderly patients with CHF were included. Nutritional status was assessed using PNI and GNRI. Patients meeting either the PNI or GNRI criteria for moderate or severe malnutrition were classified as malnourished; others were considered well-nourished. One-year all-cause mortality was evaluated using Cox regression models. Predictive performance was assessed using receiver operating characteristic analysis and DeLong's test.

RESULTS

Moderate or severe malnutrition was identified in 42.2% using the PNI and in 31.2% using the GNRI. Severe malnutrition was independently associated with higher 1-year mortality (PNI: HR 1.43, p=0.038; GNRI: HR 1.78, p=0.043). GNRI showed better post-discharge discrimination (AUC 0.666 versus 0.586, p=0.002). Prognostic value of both indices varied by BMI and inflammation. GNRI-defined malnutrition showed significant interaction with hsCRP and suPAR.

CONCLUSION

In elderly CHF patients, malnutrition was common and independently associated with mortality. Prognostic value varied by BMI and inflammation, with GNRI showing enhanced discriminatory ability. In acute care settings, PNI and GNRI may aid nutritional risk stratification.