ArticleBMC geriatrics2026
No incremental discriminative value of hemoglobin beyond GNRI for predicting mortality in older adult with sepsis.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe prognostic value of hemoglobin-combined Geriatric Nutritional Risk Index (H-GNRI) in older adult septic patients remain unexplored. This study aimed to investigate the association between H-GNRI and both short-term and long-term mortality in older adult patients with sepsis.
methodsThis retrospective cohort study analyzed older adult with sepsis from the MIMIC-IV database. Patients aged ≥ 65 years meeting sepsis-3 criteria were included, excluding those with chronic kidney disease or severe liver disease. The H-GNRI scoring system was developed by combining optimal cutoff values for GNRI and hemoglobin determined through X-tile analysis. Propensity score matching (1:1) was performed to minimize confounding. The primary outcome was 28-day mortality. Cox proportional hazards models and ROC analysis were used to evaluate prognostic performance and discriminatory ability.
resultsThe 28-day mortality rates increased significantly across risk groups (45.0%, 61.7%, and 72.5% for low, intermediate, and high-risk groups, respectively; P < 0.001). This trend persisted for 180-day and 1-year mortality. After adjusting for confounders, higher-risk H-GNRI groups remained independently associated with increased mortality risk. However, H-GNRI demonstrated poor discriminatory performance with an AUC of 0.58 for 28-day mortality prediction.
conclusionWhile H-GNRI demonstrated significant associations with mortality in older adult sepsis patients, it exhibited poor discriminatory performance, limiting its utility as a standalone risk prediction tool. Further studies are needed to develop more sophisticated nutritional risk stratification approaches for critically ill patients.
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