Geriatric Nutritional Risk Index as a Predictor of Overall Survival in Cirrhosis: A Retrospective Cohort Study

Abstract

Objective

The geriatric nutritional risk index (GNRI) is widely used for nutritional assessment. Poor nutritional status is associated with complications and poor survival in cirrhotic patients. We aimed to investigate the value of the GNRI in predicting outcomes in cirrhotic patients.

Methods

This retrospective study included 420 cirrhotic patients from three centers between 2013 and 2017. Patients were divided into the high GNRI group (≥ 92) and low GNRI group (< 92). Overall survival (OS) in the two groups was evaluated via the Kaplan‒Meier method. Cox proportional hazards model was used to estimate the value of the GNRI in predicting outcomes. Restricted cubic spline model was used to intuitively display the dose‒response associations between the GNRI and OS. A nomogram was constructed to predict OS.

Results

During the 2-year follow-up period, 58 (13.81%) patients died, and 262 (62.38%) patients experienced episodes of complications. Compared with patients in the low GNRI group, those in the high GNRI group had lower mortality rates (18.73% vs. 5.23%, P < 0.001). The GNRI was an independent predictor of OS (hazard ratio [HR] = 0.958, 95% confidence interval [CI] 0.929–0.988, P = 0.007). The GNRI was associated with the cumulative incidence of ascites (HR = 0. 954, 95% CI 0.940–0.969, P < 0.001), spontaneous bacterial peritonitis (HR = 0.928, 95% CI 0.891–0.966, P < 0.001), hepatic encephalopathy (HE; HR = 0.944, 95% CI 0.920–0.968, P < 0.001), and hepatorenal syndrome (HRS) (HR = 0.916, 95% CI 0.861–0.974, P = 0.005). Furthermore, 6 independent factors were included to construct the nomogram for OS prediction, including GNRI, age, total bilirubin, serum sodium, history of HE and HRS. The C statistics of our model were 0.83 (95% CI 0.75–0.90) and 0.80 (95% CI 0.73–0.86) at 1 and 2 years, respectively. Patients whose GNRI score decreased within 3 and 6 months had poorer outcomes (P < 0.001).

Conclusions

The lower GNRI score was associated with the higher cumulative incidence of complications and poorer OS of cirrhotic patients. The GNRI could be a helpful tool for assessing nutritional status and prognosis of these patients.

Keywords

Geriatric nutritional risk index / Liver cirrhosis / Nutrition / Predictor / Prognosis

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Funding

Joint Tackling Project of Pudong Health Committee of Shanghai(PW2022D08)

Medical Discipline Construction Project of Pudong Health Committee of Shanghai(PWZxq2022-6)

Health and Family Planning Research Project of Pudong Health Committee of Shanghai(PW2021A-38)

Youth Scientific Research Cultivation Fund Project of Shanghai Oriental Hospital(DFPY2022020)

RIGHTS & PERMISSIONS

The Author(s), under exclusive licence to Huazhong University of Science and Technology