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New research · Geriatrics
Frontiers in cardiovascular medicine · 1d
Cohort studyFrontiers in cardiovascular medicine · 2026

Geriatric nutritional risk Index predicts adverse outcomes across cardiovascular-kidney-metabolic syndrome: discovery in NHANES and external validation in CKM stage 4 patients undergoing PCI.

Hongyan Zhu, Jing Yang, Yuqi Fang, Yizhu Yan
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GeriatricsCohort study

Lowest Geriatric Nutritional Risk Index is associated with higher MACE.

Geriatric nutritional risk Index predicts adverse outcomes across cardiovascular-kidney-metabolic syndrome: discovery in NHANES and external validation in CKM stage 4 patients undergoing PCI.

Hongyan Zhu et al. · Frontiers in cardiovascular medicine · 2026
Background

Cardiovascular-kidney-metabolic (CKM) syndrome imposes a high burden of adverse events, yet prognostic biomarkers remain scarce.

Methods

This discovery-validation study utilized 16,074 adults with CKM syndrome from NHANES (1999-2018) and an external validation cohort of 2,401 CKM Stage 4 patients undergoing PCI.

n = 16,074 adults
Results

the lowest nutritional risk index meant a higher risk of serious heart problems

HR by subgroup · 95% CI
null = 1
hazards of all-cause
1.58
cardiovascular mortality
2.13
hazard of all-cause mortality
0.95
MACE
2.52
MACE
0.95
More results

In the discovery cohort, compared with the highest GNRI quartile (Q4), Q1 was associated with significantly higher hazards of all-cause (HR 1.58; 95% CI 1.32-1.89) and cardiovascular mortality (HR 2.13; 95% CI 1.55-2.93); each 1-unit increase in GNRI was associated with a lower hazard of all-cause mortality (HR 0.95; 95% CI 0.94-0.97).

More results

Restricted cubic splines revealed a non-linear inverse relationship, with risk rising sharply below GNRI ≈ 100.

Adding GNRI to a base clinical model significantly improved Harrell's C-index for MACE (Δ +0.048, P < 0.001) with excellent calibration.

“
Conclusion · 1 of 3

Lower GNRI is independently associated with adverse outcomes across the CKM spectrum.

Conclusion · 2 of 3

In an external CKM Stage 4 PCI cohort, GNRI provided clinically meaningful incremental risk discrimination, supporting its use as an inexpensive marker to help identify higher-risk patients.

Conclusion · 3 of 3

Whether GNRI-guided management improves outcomes remains to be determined.

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