Association and predictive value of preoperative nutritional risk index with one-year mortality in heart transplant recipients from a understudied population

Background

Preoperative nutritional status plays a critical role in surgical outcomes. While the Nutritional Risk Index (NRI) has prognostic value in diverse surgical cohorts, its use in heart transplantation (HTx) remains unclear in populations with limited organ donation rates and distinct post-transplant care environments.

Methods

This retrospective study involved patients who underwent HTx from January 2013 to December 2016. Preoperative health data were collected, NRI scores were calculated, and all-cause mortality was recorded during a one-year follow-up. The relationship between NRI and all-cause mortality at 30, 90, 180, and 360 days were analyzed using restricted cubic spline (RCS) and multivariate logistic regression models. The optimal NRI cut-off for mortality prediction was identified using the Youden index.

Results

A total of 186 patients were analyzed, with 15 (8.06 %) deaths recorded within 360 days. The mortality group had significantly lower NRI scores compared to the survival group (103.80 vs. 107.48). Each 1-point increase in NRI was associated with a 10 % reduction in mortality risk at 90 and 180 days (Odds ratio [OR]: 0.90, p = 0.04) and an 8 % reduction at 360 days (OR: 0.92, p = 0.05). The optimal NRI cutoffs for predicting mortality were 108.6, 105.68, 105.68, and 109.01 at 30, 90, 180, and 360 days, respectively, as determined by the Youden index.

Conclusion

There was a linear association between preoperative NRI and one-year mortality for patients with heart transplant. Our findings challenge conventional NRI thresholds, suggesting higher cut-offs may better stratify risk in populations with unique nutritional profiles and healthcare resource allocation patterns.