Abstract
BACKGROUND: Malnutrition is a significant prognostic factor in chronic heart failure (CHF), particularly among older adults. The geriatric nutritional risk index (GNRI) is a screening tool for assessing malnutrition in this population. Although low GNRI is associated with increased deaths of patients with HF, the prognostic impact of longitudinal GNRI changes in malnourished patients remains unclear. METHODS AND RESULTS: This post-hoc analysis of the KUNIUMI registry chronic cohort, a prospective observational study of patients with pre-HF/HF, assessed GNRI at baseline and 1-year follow-up. The annual GNRI change (∆GNRI) was calculated, and its association with all-cause death in malnourished patients was analyzed. The primary outcome was all-cause death, with a 2-year follow-up after the initial 1-year assessment. Among 1,242 patients (mean age: 74.4±10.9 years), 19.8% had low GNRI (<92). All-cause death was significantly higher in patients with low GNRI than in those with high GNRI (30.1% vs. 7.1%; P<0.001). In patients with low GNRI, multivariable Cox regression showed a significant association between ∆GNRI and death (hazard ratio: 0.94; 95% confidence interval: 0.91-0.96; P<0.001). Multiple linear regression indicated that nutritional counseling positively influenced ∆GNRI, but HF severity was not significantly associated. CONCLUSIONS: ∆GNRI is a significant prognostic indicator in malnourished patients with pre-HF/HF. Serial GNRI assessments may improve risk stratification and guide nutritional interventions.