ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
Geriatric Nutritional Risk Index improves risk scoring for mortality after TAVR compared to established scores
Johannes Boehm 1
Andrea Amabile 2
Hendrik Ruge 1
Martin Bichler 1
Stefan Holdenrieder 3
Melchior Burri 1
Markus Krane 1
1. 1) Department of Cardiovascular Surgery, Institute Insure, TUM University Hospital - German Heart Center, TUM School of Medicine & Health, Technical University of Munich, Munich, Germany, Munich, Germany
2. 2) Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA, Pittsburgh, United States
3. 4) Institute for Laboratory Medicine, German Heart Center, Technical University of Munich, Munich, Germany, Munich, Germany
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Abstract
Background: Risk scoring prior TAVR is based on the EuroSCORE II (European System for Cardiac Operative Risk Evaluation) and the STS-score (Society of Thoracic Surgeons) which are complex, and partly prone to investigator bias. The geriatric nutritional risk index (GNRI) can be calculated by five parameters via publicly available formula (age, height, weight, sex, serum albumin), whereas EuroSCORE II and the STS-score require 21 and 69 variables, respectively. The study compares the efficiency of GNRI in predicting 30-day mortality compared to the EuroSCORE II and the STS-score. Furthermore, GNRI risk classes were analysed in the long-term. Methods: 3.470 consecutive patients who underwent TAVR between 2010 and 2023 at our institution were analysed. GNRI calculation produces a linear parameter that can be divided in four risk groups. Results: ROC (receiver operating characteristic) curve analysis demonstrated no difference in predicting 30-day mortality between GNRI vs. EuroSCORE II (AUC=0.72 vs. 0.69, p=0.3) and GNRI vs. STS-score (AUC=0.72 vs. 0.72, p=1.0). The Hosmer-Lemeshow test indicated good calibration for the GNRI model (p = 0.3793). After adjustment for preoperative demographic characteristics, Cox regression analysis for overall survival after TAVR reveals for the major risk group (21 patients; HR=4.624; CI95%[2.881–7.422]; p<0.0001), the moderate risk group (198 patients (5.7%), HR=2.201; CI95%[1.821-2.660]; p<0.0001), and the low risk group (452 patients (13.0%); HR=1.831; CI95%[1.597– 2.1]; p<0.0001), respectively. Conclusions: The GNRI is an objective publicly available score that simplifies risk assessment prior TAVR without any loss of precision compared to the EuroSCORE II and the STS-score.
Summary
Keywords
30-day mortality, Geriatrics, GNRI, Nutritional scores, Outcome analysis, Risk scoring, TAVR
Received
23 December 2025
Accepted
10 February 2026
Copyright
© 2026 Boehm, Amabile, Ruge, Bichler, Holdenrieder, Burri and Krane. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Johannes Boehm
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