{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:21:18Z","timestamp":1783405278733,"version":"3.54.6"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome imposes a high burden of adverse events, yet prognostic biomarkers remain scarce. We evaluated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) across CKM stages 1\u20134 and in high-risk patients undergoing percutaneous coronary intervention (PCI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This discovery\u2013validation study utilized 16,074 adults with CKM syndrome from NHANES (1999\u20132018) and an external validation cohort of 2,401 CKM Stage 4 patients undergoing PCI. Primary outcomes were all-cause mortality (discovery) and major adverse cardiovascular events (MACE; validation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the discovery cohort, compared with the highest GNRI quartile (Q4), Q1 was associated with significantly higher hazards of all-cause (HR 1.58; 95% CI 1.32\u20131.89) and cardiovascular mortality (HR 2.13; 95% CI 1.55\u20132.93); each 1-unit increase in GNRI was associated with a lower hazard of all-cause mortality (HR 0.95; 95% CI 0.94\u20130.97). In the validation cohort, Q1 vs. Q4 conferred a markedly increased risk of MACE (HR 2.52; 95% CI 2.03\u20133.13), with each 1-unit increase in GNRI associated with a lower risk of MACE (HR 0.95; 95% CI 0.94\u20130.96). Restricted cubic splines revealed a non-linear inverse relationship, with risk rising sharply below GNRI\u2009\u2248\u2009100. Adding GNRI to a base clinical model significantly improved Harrell's C-index for MACE (\u0394 +0.048,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) with excellent calibration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower GNRI is independently associated with adverse outcomes across the CKM spectrum. In an external CKM Stage 4 PCI cohort, GNRI provided clinically meaningful incremental risk discrimination, supporting its use as an inexpensive marker to help identify higher-risk patients. Whether GNRI-guided management improves outcomes remains to be determined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1878842","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:48:08Z","timestamp":1783403288000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Geriatric nutritional risk Index predicts adverse outcomes across cardiovascular\u2013kidney\u2013metabolic syndrome: discovery in NHANES and external validation in CKM stage 4 patients undergoing PCI"],"prefix":"10.3389","volume":"13","author":[{"given":"Hongyan","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Beijing Luhe Hospital Affiliated to Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Luhe Hospital Affiliated to Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqi","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Luhe Hospital Affiliated to Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhu","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Luhe Hospital Affiliated to Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1038\/s41581-022-00616-6","article-title":"Epidemiology and risk of cardiovascular disease in populations with chronic kidney disease","volume":"18","author":"Matsushita","year":"2022","journal-title":"Nat 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