The role of geriatric nutritional risk index in predicting survival of type B aortic dissection patients after thoracic endovascular aortic repair.

BACKGROUND

The geriatric nutritional risk index (GNRI) is a reliable indicator of patients' nutrition status and has been shown to be valuable in predicting the outcome of patients with various cardiovascular diseases. This study explored the association between perioperative GNRI and the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR).

METHODS

A total of 1,157 consecutive patients who underwent TEVAR between January 2007 and August 2019 were included, with data from 789 patients analyzed. The GNRI was used to measure nutritional status. Patients were categorized into five groups based on the GNRI quintile. The study's endpoints included all-cause mortality, aortic-related adverse events (ARAEs), and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days, 1 year, and 5 years. The univariate and multivariate Cox regression analyses the effect of GNRI on the endpoints. Kaplan-Meier survival analysis was conducted to assess the incidence of these endpoints across the five groups, and restricted cubic spline (RCS) analysis was used to examine the non-linear relationship between GNRI and all-cause mortality.

RESULTS

The Kaplan-Meier survival analyses revealed that the risk of 1-year and 5-year all-cause mortality was highest in the Q1 group among the five groups (P = 0.009 and P = 0.002, respectively). However, there was no significant difference in 1-year and 5-year ARAEs and MACCEs (all P > 0.05). Multivariate Cox analysis showed that continuous GNRI was independently associated with 5-year all-cause death (HR = 0.97, 95% CI: 0.95-1.00; P = 0.027). Compared with the Q1 group, the Q2 (HR = 0.22, 95% CI: 0.06-0.80; P = 0.021) and Q4 groups (HR = 0.26, 95% CI: 0.08-0.81; P = 0.020) had lower risks of 1-year all-cause mortality. The Q2 group (HR = 0.38, 95% CI: 0.18-0.83; P = 0.015) and Q3 group (HR = 0.46, 95% CI: 0.22-0.96; P = 0.039) were also observed to have a lower risk of 5-year all-cause mortality than the Q1 group. In the subgroup analyses, chronic kidney disease (CKD) showed significant interaction (P-interaction < 0.001). Besides, the RCS analysis identified a "U"-shaped relationship between GNRI and all-cause mortality of TBAD patients following TEAVR.

CONCLUSIONS

TBAD patients undergoing TEVAR showed a strong correlation between perioperative low GNRI and higher risks of 1-year and 5-year all-cause mortalities. TBAD patients with a too low GNRI should receive particular attention.