Geriatric nutritional risk index predicts all-cause mortality in patients with heart failure: an updated systematic review and meta-analysis

Abstract

Objectives: The role of malnutrition in heart failure (HF) patients is unclear. We assessed the correlation between the Geriatric Nutritional Risk Index (GNRI) and all-cause mortality in HF. Methods: PubMed, Scopus, and Web of Science were searched for observational studies reporting the correlation between GNRI and all-cause mortality in HF patients (up to January 26, 2025). Titles, abstracts, and full texts were screened. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Data were synthesized via randomeffects meta-analysis using the restricted maximum likelihood (REML) method. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Nineteen observational studies with 9,982 subjects were included. A low-risk GNRI group was correlated with raised all-cause mortality in HF patients (hazard ratio (HR) 1.77, 95 CI 1.38-2.16; P < 0.0001). Results were consistent across sensitivity analyses. Heterogeneity was high (I2 = 99.5), and meta-regression explained 18.9 of the variance. Egger's test demonstrated possible publication bias (P = 0.0305). The high GNRI subgroup (5 studies, 2,193 patients) had a pooled HR of 3.15 (95 CI 0.93-5.37; P = 0.0055). The CI included 1.0, indicating some uncertainty. Conclusion: GNRI is a reliable nutritional tool predicting all-cause mortality in HF patients. Our study suggests GNRI should be considered for evaluating long-term prognosis in this population.