The geriatric nutritional risk index as a prognostic risk factor for critically ill patients with atrial fibrillation: a retrospective study based on MIMIC-IV and local hospital cohort external validation.
Malnutrition is known to worsen outcomes in many diseases. This study explored its effect on prognosis in critically ill patients with atrial fibrillation (AF).
A total of 4,564 patients were studied. Their nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and they were divided into four groups based on GNRI quartiles, with a median of 100.23 and interquartile range of 90.31-111.27. The primary outcome was 28-day mortality. Kaplan-Meier analysis evaluated survival differences among the GNRI groups, and a multivariate Cox model assessed GNRI's independent effect on mortality risk. A restricted cubic spline (RCS) analysis explored potential non-linear associations between GNRI and 28-day mortality.
There is a negative correlation between GNRI and 28-day mortality, a finding supported by a log-rank test result with p < 0.001. According to the multivariate analysis, higher GNRI values were independently associated with a lower risk of 28-day mortality (quartile 4 compared to quartile 1, the hazard ratio (HR) was 0.78 with a 95% confidence interval (CI) of 0.62-0.97, and p = 0.029). Subgroup analysis showed no association in those with obesity, or in cardiovascular ICUs or post-cardiac surgery settings. No link was found in patients with a history of AF or on CRRT. However, the association was consistently seen in septic patients with new-onset AF. Additionally, the RCS analysis revealed a non-linear relationship between GNRI and 28-day mortality, showing that as GNRI increased, the risk of 28-day mortality decreased among patients. Findings from external validation cohorts also confirm this relationship.
Among critically ill patients, elevated GNRI scores are associated with improved outcomes in patients with new-onset AF, but this association is not present in patients with preexisting AF. In the subgroup of septic patients with new-onset AF, GNRI may not reliably predict clinical prognosis, emphasizing the need for further validation prior to clinical use. The GNRI provides a straightforward, unbiased assessment of both nutritional status and systemic inflammation burden.
A total of 4,564 patients were studied. Their nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and they were divided into four groups based on GNRI quartiles, with a median of 100.23 and interquartile range of 90.31-111.27. The primary outcome was 28-day mortality. Kaplan-Meier analysis evaluated survival differences among the GNRI groups, and a multivariate Cox model assessed GNRI's independent effect on mortality risk. A restricted cubic spline (RCS) analysis explored potential non-linear associations between GNRI and 28-day mortality.
There is a negative correlation between GNRI and 28-day mortality, a finding supported by a log-rank test result with p < 0.001. According to the multivariate analysis, higher GNRI values were independently associated with a lower risk of 28-day mortality (quartile 4 compared to quartile 1, the hazard ratio (HR) was 0.78 with a 95% confidence interval (CI) of 0.62-0.97, and p = 0.029). Subgroup analysis showed no association in those with obesity, or in cardiovascular ICUs or post-cardiac surgery settings. No link was found in patients with a history of AF or on CRRT. However, the association was consistently seen in septic patients with new-onset AF. Additionally, the RCS analysis revealed a non-linear relationship between GNRI and 28-day mortality, showing that as GNRI increased, the risk of 28-day mortality decreased among patients. Findings from external validation cohorts also confirm this relationship.
Among critically ill patients, elevated GNRI scores are associated with improved outcomes in patients with new-onset AF, but this association is not present in patients with preexisting AF. In the subgroup of septic patients with new-onset AF, GNRI may not reliably predict clinical prognosis, emphasizing the need for further validation prior to clinical use. The GNRI provides a straightforward, unbiased assessment of both nutritional status and systemic inflammation burden.