Geriatric Nutrition Risk Index is Associated with LVAD Recipient Survival with Cutoff Value of 92.68

Abstract

Purpose Malnutrition is a common problem in the heart failure population. The Geriatric Nutritional Risk Index (GNRI) is commonly adopted scoring system that evaluates patients' nutritional status. GNRI has been reported to have significant prognostic value and independent risk factor for adverse events in patients with heart failure as well as those undergoing various surgeries. There is a paucity of GNRI data in left ventricular assisted device (LVAD) recipients and a GNRI cutoff value for LVAD patient assessment has not yet been reported. Our aim of study is to analyze patient outcomes related to preoperative GNRI and develop a GNRI cutoff value for worse overall survival to enable better patient selection. Methods 120 end stage heart failure patients who underwent primary LVAD implantation from January 2015 to February 2018 were included in our single institution retrospective study. GNRI was determined using the formula (1.489 × albumin in g/l) + (41.7 × present/ideal body weight). Receiver operation characteristic (ROC) curve was used to determine a cut off GNRI value for worse overall mortality on LVAD support. We defined two groups with this cutoff as high or low GNRI groups. The perioperative demographics, post-operative complications and survival were analyzed between these two groups. Univariate analysis was used to evaluate GNRI as an independent risk factor for mortality. Results ROC curve demonstrated a cut off GNRI value for overall survival as 92.68. High GNRI group (n=95) and low GNRI group (n=25) were defined from this cut off value. Kaplan Meier curve showed significant overall mortality between 2 groups (p=0.031). Univariate analysis showed GNRI p-value of 0.051. Conclusion We have successfully shown that GNRI below a cutoff value of 92.68 to be associated for worse outcomes in LVAD recipients including worse overall mortality. For these patients, it is important to consider the surgical indication, timing and nutrition optimization prior to LVAD implantation.