Geriatric nutritional risk index may predict development of AF after cardiac surgery

Nearly one-third of hospitalized patients have malnutrition or are at risk of malnutrition at the time of admission. Chronic malnutrition and a high risk of malnutrition have been linked to longer intensive care unit (ICU) and hospital stays, severe postoperative sequelae, and death after heart surgery. In clinical practice, many regular nutritional screening methods are available, ranging from basic metrics like weight loss and body mass index to complicated assessments like the Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, and the Short Nutritional Assessment Questionnaire. However, these nutritional screening measures were not initially designed with cardiac surgery patients in mind, and their sensitivity and specificity have not been well shown. The Geriatric Nutritional Risk Index (GNRI) has shown its dependability and stability as a straightforward and readily accessible nutritional evaluation tool for older patients with heart failure, hemodialysis, or cancer. Researchers assessed the usefulness of the GNRI as a nutritional status evaluation prior to adult cardiac surgery.

The authors investigated mortality and readmission over a 90-day follow-up period for 292 patients who had heart surgery and exhibited postoperative atrial fibrillation during hospitalization. Within 48 hours of admission, the preoperative nutritional status was examined using the GNRI. GNRI was calculated using the following formula: GNRI = [1.489 × albumin (g/dL)] + [41.7 × body weight (kg)/ideal body weight (kg)]. The ideal body weight (kg) for men was calculated as: height (cm) − 100 − [(height (cm) − 150)/4]. For women it was calculated as: height (cm) − 100 − [(height (cm) − 150)/2.5].16 According to previously described cut-offs for GNRI, 16,23-25 the patients were stratified into two groups according to malnutrition risk as: no-risk (GNRI ≥98), and low-risk (GNRI <98) groups. The participants were separated into low-risk (Geriatric Nutritional Risk Index 98) and no-risk (Geriatric Nutritional Risk Index 98) malnutrition groups. There were a total of 136 patients in the group at low risk for malnutrition. Postoperative atrial fibrillation was more prevalent in the low-risk group (63.2% vs 28.0%, P.001). Hospitalization and intensive care unit stays were considerably higher in the high-risk group (44(43) against 39(47) hours, P.001; 18(7) versus 15(6) days, P.001, respectively). Independently predicting postoperative atrial fibrillation were the Geriatric Nutritional Risk Index, age, and NYHA class, according to a multivariate analysis. Analysis by Kaplan–Meier revealed that 90-day all-cause readmission, but not 90-day all-cause death, varied across groups based on the Geriatric Nutritional Risk Index (log-rank P .001, log-rank P = 0.09).

The authors discovered that GNRI was believed to have a predictive effect in POAF and was related with an increase in the 90-day readmission rate for all causes. Malnutrition is prevalent among hospitalized patients and is defined by a reduction in physical performance due to inadequate food intake, resulting in alterations in body composition (decreased fat-free mass) and cell mass. The GNRI is a generally established and readily accessible nutritional evaluation tool for the elderly.

In clinical practice, calculating the GNRI using serum albumin, actual body weight, and ideal body weight index is a straightforward process. This is the first research to examine the predictive role of GNRI in the development of POAF in cardiac surgery patients. The readily available GNRI utilized for preoperative nutritional evaluation before to cardiac surgery may predict the occurrence of POAF and is associated with short-term readmission rates.

Reference-

Wu, Liuyang, et al. "Does the Geriatric Nutritional Risk Index Have a Predictive Role in Postoperative Atrial Fibrillation and Outcomes in Cardiac Surgery?" Journal of Cardiothoracic and Vascular Anesthesia, vol. 0, no. 0, 2022, https://doi.org10.1053/j.jvca.2022.09.097.