Geriatric nutritional risk index as a predictor of outcomes in elderly patients undergoing percutaneous coronary intervention: An updated systematic review and meta-analysis

Abstract

Objective: To assess the association between Geriatric Nutritional Risk Index (GNRI) and outcomes in elderly patients undergoing percutaneous coronary intervention (PCI).

Methodology: A systematic search of PubMed, Web of Science, Scopus, and Embase databases was done to identify observational studies that reported adjusted effect sizes for the outcomes of interest, such as all-cause mortality (ACM), major adverse cardiovascular events (MACEs) and contrast-induced acute kidney injury (CI-AKI). Databases were searched from inception of the databases and until April 30, 2024. Subgroup analysis was conducted based on underlying cardiac condition, follow up duration, sample size and quality score. Analysis using random effects model was conducted in STATA version 15.0. Publication bias was assessed using Egger’s test and funnel plot.

Results: A total of 24 studies with 35002 participants were included. Low GNRI scores were associated with the increased risk of ACM (HR 2.50, 95% CI: 2.08, 3.00; n=13, I2=39.8%) and MACE (HR 2.18, 95% CI: 1.58, 3.01; n=11, I2=95.0%) compared to high GNRI scores. The risk of CI-AKI was higher in patients with low GNRI score (HR 1.87, 95% CI: 1.41, 2.48; n=2, I2=0.0%). Significant association of low GNRI scores and increased risk of ACM and MACEs was consistent in all subgroup analyses. Evidence of publication bias was found for ACM and MACEs outcomes.

Conclusion: This study demonstrated a consistent association between low GNRI scores and increased risks of ACM, MACEs and CI-AKI in older patients undergoing PCI. Evidence of publication bias warrants cautious interpretation. Our findings underscore the importance of nutritional assessment and intervention to improve outcomes in at-risk populations.