Frontiers in cardiovascular medicine · 2026
Geriatric nutritional risk Index predicts adverse outcomes across cardiovascular-kidney-metabolic syndrome: discovery in NHANES and external validation in CKM stage 4 patients undergoing PCI.
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Zhu Hongyan, Yang Jing, Fang Yuqi, Yan Yizhu
Аннотация
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome imposes a high burden of adverse events, yet prognostic biomarkers remain scarce. We evaluated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) across CKM stages 1-4 and in high-risk patients undergoing percutaneous coronary intervention (PCI).
METHODS: This discovery-validation study utilized 16,074 adults with CKM syndrome from NHANES (1999-2018) and an external validation cohort of 2,401 CKM Stage 4 patients undergoing PCI. Primary outcomes were all-cause mortality (discovery) and major adverse cardiovascular events (MACE; validation).
RESULTS: In the discovery cohort, compared with the highest GNRI quartile (Q4), Q1 was associated with significantly higher hazards of all-cause (HR 1.58; 95% CI 1.32-1.89) and cardiovascular mortality (HR 2.13; 95% CI 1.55-2.93); each 1-unit increase in GNRI was associated with a lower hazard of all-cause mortality (HR 0.95; 95% CI 0.94-0.97). In the validation cohort, Q1 vs. Q4 conferred a markedly increased risk of MACE (HR 2.52; 95% CI 2.03-3.13), with each 1-unit increase in GNRI associated with a lower risk of MACE (HR 0.95; 95% CI 0.94-0.96). Restricted cubic splines revealed a non-linear inverse relationship, with risk rising sharply below GNRI ≈ 100. Adding GNRI to a base clinical model significantly improved Harrell's C-index for MACE (Δ +0.048, P < 0.001) with excellent calibration.
CONCLUSIONS: Lower GNRI is independently associated with adverse outcomes across the CKM spectrum. In an external CKM Stage 4 PCI cohort, GNRI provided clinically meaningful incremental risk discrimination, supporting its use as an inexpensive marker to help identify higher-risk patients. Whether GNRI-guided management improves outcomes remains to be determined.
METHODS: This discovery-validation study utilized 16,074 adults with CKM syndrome from NHANES (1999-2018) and an external validation cohort of 2,401 CKM Stage 4 patients undergoing PCI. Primary outcomes were all-cause mortality (discovery) and major adverse cardiovascular events (MACE; validation).
RESULTS: In the discovery cohort, compared with the highest GNRI quartile (Q4), Q1 was associated with significantly higher hazards of all-cause (HR 1.58; 95% CI 1.32-1.89) and cardiovascular mortality (HR 2.13; 95% CI 1.55-2.93); each 1-unit increase in GNRI was associated with a lower hazard of all-cause mortality (HR 0.95; 95% CI 0.94-0.97). In the validation cohort, Q1 vs. Q4 conferred a markedly increased risk of MACE (HR 2.52; 95% CI 2.03-3.13), with each 1-unit increase in GNRI associated with a lower risk of MACE (HR 0.95; 95% CI 0.94-0.96). Restricted cubic splines revealed a non-linear inverse relationship, with risk rising sharply below GNRI ≈ 100. Adding GNRI to a base clinical model significantly improved Harrell's C-index for MACE (Δ +0.048, P < 0.001) with excellent calibration.
CONCLUSIONS: Lower GNRI is independently associated with adverse outcomes across the CKM spectrum. In an external CKM Stage 4 PCI cohort, GNRI provided clinically meaningful incremental risk discrimination, supporting its use as an inexpensive marker to help identify higher-risk patients. Whether GNRI-guided management improves outcomes remains to be determined.