Geriatric Nutritional Risk Index: A Valuable Predictor for Elderly with Bloodstream Infections
Malnutrition is a common and critical determinant of outcomes in hospitalized patients, especially among the elderly. While bloodstream infections (BSIs) pose severe risks on their own, nutritional status may amplify vulnerability and hinder recovery. The Geriatric Nutritional Risk Index (GNRI) is a simple, evidence-based tool designed to assess nutrition-related risk in older adults. This retrospective study investigates whether GNRI measured at hospital admission can forecast adverse outcomes, including in-hospital mortality, among elderly patients with BSIs.
Study Snapshot: GNRI and Mortality in Elderly BSI Patients
Over a two-year period in a large Chinese tertiary hospital, researchers identified 464 inpatients aged 60 years and older who developed healthcare-associated BSIs. Patients were categorized by GNRI into four groups: no nutritional risk (>98), low risk (92–98), moderate risk (82–92), and major risk (98, 70 (15.1%) at low risk, 118 (25.4%) at moderate risk, and 73 (15.7%) at major risk.
Mortality analysis revealed a clear, graded relationship: higher GNRI-related risk was associated with greater in-hospital death. After adjusting for multiple covariates, GNRI remained an independent predictor. Patients with GNRI <82 (major risk) had an odds ratio (OR) of 3.16 for mortality (95% CI: 1.52–6.58; P = 0.002). Those with GNRI 82–<92 (moderate risk) had an OR of 1.91 (95% CI: 1.00–3.62; P = 0.049). In contrast, every unit increase in GNRI conferred a protective effect (OR: 0.96; 95% CI: 0.94–0.98; P = 0.001).
Beyond linear analysis, the study employed a restricted cubic spline (RCS) to explore nonlinear associations. The RCS curve showed that mortality risk declines as GNRI rises, with the most pronounced effects at lower GNRI values. The curve levels off and becomes relatively stable when GNRI reaches approximately 96–98, suggesting that even modest GNRI improvements in severely malnourished patients could yield meaningful survival benefits.
Clinical Implications: Using GNRI to Guide Care
The findings position GNRI as a practical, low-burden tool for early nutritional risk stratification in elderly BSI patients. Since GNRI relies on albumin, height, and weight—data routinely collected at admission—it can be calculated without extra testing. Clinicians can use GNRI to identify patients who may benefit from timely nutritional interventions, closer monitoring, and tailored therapies that support immune function and tissue repair during and after BSI management.
The study also highlights the impact of invasive devices. In univariate analyses, the use of indwelling urinary catheters and central venous catheters correlated with higher mortality, underscoring the need to balance infection risk with the benefits of life-sustaining support in frail patients. A proactive nutritional plan, combined with careful device management and infection control, may help mitigate the overall risk profile of elderly BSI patients.
Limitations and Future Directions
As a single-center, retrospective study, generalizability is limited. GNRI was measured only at admission, and longitudinal changes were not captured. Potential biases inherent in observational designs remain a concern despite multivariate adjustments and cross-validation. Future multicenter, prospective studies should track GNRI trajectories over time and examine how targeted nutritional interventions informed by GNRI influence short- and long-term outcomes in elderly BSI patients.
Conclusion: GNRI as a Practical Prognostic Tool in Geriatric BSI Care
This study provides evidence that GNRI is a meaningful, independent predictor of adverse outcomes in elderly patients with BSIs and reveals a nonlinear association with mortality. Clinicians should consider routine GNRI assessment at admission to identify high-risk patients and implement timely nutritional support, potentially improving survival in this vulnerable population.
