Comparative prognostic value of GNRI, PNI, and CONUT scores for long-term mortality in patients undergoing transcatheter aortic valve replacement

Abstract

Objective: This study aimed to comparatively evaluate the association between geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) scores and long-term mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Method: This retrospective observational study included 262 patients who underwent TAVR for severe symptomatic aortic stenosis between January 2015 and December 2018. Patients were divided into two groups based on all-cause mortality development during 7.6 years of follow-up: survivors and those who died. Nutritional status was assessed using pre-admission laboratory and anthropometric data, as well as GNRI, PNI, and CONUT scores. Results: The mean age was 79.0 ± 6.4 years, and 45% of the patients were female. During the follow-up period, 106 patients (40.5%) died. Malnutrition prevalence was found to be 79.8% according to GNRI, 63.7% according to PNI, and 60.7% according to CONUT. In univariate analysis, GNRI (HR: 0.974, p = 0.035), PNI (HR: 0.959, p = 0.007), and CONUT (HR: 1.140, p < 0.001) were significantly associated with mortality. However, in multivariate analysis, none of these scores remained as independent predictors. In ROC analysis, AUC values for GNRI, CONUT, and PNI were found to be 0.626, 0.610, and 0.590, respectively. In Kaplan-Meier analysis, survival was lower in patients with poor nutritional status (log-rank p < 0.001). Conclusion: In patients undergoing TAVR, impaired nutritional status is associated with long-term mortality; However, GNRI, PNI, and CONUT scores are not clinically independent predictors of mortality. These scores may provide complementary information regarding nutritional status but showed limited discriminatory ability for mortality prediction. © The Author(s) 2026.