{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:37:06Z","timestamp":1776926226976,"version":"3.51.2"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"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. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malnutrition has been suggested as an important contributor to postoperative delirium (POD). The geriatric nutritional risk index (GNRI), a simple indicator based on serum albumin and body weight, has been increasingly evaluated in surgical patients. This meta-analysis aimed to clarify the association between GNRI and the risk of POD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, and Web of Science were searched for observational studies evaluating the association between categorized GNRI and POD. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models accounting for heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve cohort studies involving 12,332 surgical patients were included. Overall, low GNRI was associated with a significantly increased risk of POD (RR\u00a0=\u00a01.62, 95% CI: 1.34\u20131.96; I\u00b2 = 27%). Subgroup analyses showed a stronger association in studies with mean patient age &amp;gt; 74 years compared to \u2264 74 years (\n                      <jats:italic>p<\/jats:italic>\n                      for subgroup difference = 0.02) and in those using GNRI cutoffs &amp;lt; 98 compared to \u2265 98 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04). The association was weaker in studies using multivariate analyses compared with univariate analyses (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01). Meta-regression indicated that GNRI cutoff values significantly influenced the pooled effect (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04). The funnel plot showed mild asymmetry, whereas Egger\u2019s test was not significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.11), and trim-and-fill analysis produced a similar pooled estimate (RR\u00a0=\u00a01.54, 95% CI: 1.26\u20131.87).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low GNRI is associated with an increased risk of POD in surgical patients, suggesting that preoperative nutritional assessment may help identify individuals at higher risk for this complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>The study protocol was registered prospectively in the PROSPERO database (registration number: CRD420261335609).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1826824","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:37:49Z","timestamp":1776922669000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between the geriatric nutritional risk index and postoperative delirium: a meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Dandan","family":"Han","sequence":"first","affiliation":[{"name":"Anesthesiology Department, Women\u2019s Hospital, School of Medicine Zhejiang University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingsi","family":"Liang","sequence":"additional","affiliation":[{"name":"Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Chen","sequence":"additional","affiliation":[{"name":"Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Wuxi Medical College, Jiangnan University","place":["Wuxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Chen","sequence":"additional","affiliation":[{"name":"Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2026.1759910","article-title":"Recent advances in postoperative delirium in elderly patients: pathophysiological mechanisms, risk prediction, and therapeutic strategies","volume":"20","author":"Ding","year":"2026","journal-title":"Front Neurosci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/ana.0000000000000971","article-title":"Postoperative delirium and the older adult: Untangling the confusion","volume":"36","author":"Thedim","year":"2024","journal-title":"J Neurosurg Anesthesiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/9781118799574.ch14","article-title":"Delirium in older persons: Advances in diagnosis and treatment","volume":"318","author":"Oh","year":"2017","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1038\/s41598-024-84554-2","article-title":"Incidence and risk factors of postoperative delirium in elderly surgical patients 2023","volume":"15","author":"Fenta","year":"2025","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/anae.15607","article-title":"Evidence-based strategies to reduce the incidence of postoperative delirium: A narrative review","volume":"77","author":"Swarbrick","year":"2022","journal-title":"Anaesthesia"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-026-01423-z","article-title":"Associations of postoperative delirium with perioperative frailty worsening and their combined effect on 1-year mortality in older surgical patients: A prospective cohort study","author":"Han","year":"2026","journal-title":"Eur Geriatr Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.2273","article-title":"Association of delirium with long-term cognitive decline: A meta-analysis","volume":"77","author":"Goldberg","year":"2020","journal-title":"JAMA Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2023.111221","article-title":"Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis","volume":"90","author":"Yan","year":"2023","journal-title":"J Clin Anesth"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106063","article-title":"Risk factors for postoperative delirium: An umbrella review of systematic reviews","volume":"93","author":"Bramley","year":"2021","journal-title":"Int J Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13741-023-00345-9","article-title":"The impact of preoperative malnutrition on postoperative delirium: A systematic review and meta-analysis","volume":"12","author":"Dong","year":"2023","journal-title":"Perioper Med (Lond)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2023.1275201","article-title":"Perioperative cognition in association with malnutrition and frailty: A narrative review","volume":"17","author":"Dammavalam","year":"2023","journal-title":"Front Neurosci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1601021","article-title":"Bridging nutrition and neurology: Malnutrition's role in perioperative neurocognitive disorders","volume":"12","author":"Luo","year":"2025","journal-title":"Front Nutr"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2013.12.005","article-title":"The validity of geriatric nutrition risk index: Simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with mini nutritional assessment","volume":"33","author":"Abd-El-Gawad","year":"2014","journal-title":"Clin Nutr"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1628671","article-title":"Prognostic value of the geriatric nutritional risk index in patients undergoing cardiac surgery: A systematic review and meta-analysis","volume":"12","author":"Luo","year":"2025","journal-title":"Front Nutr"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.11430","article-title":"The preoperative geriatric nutritional risk index predicts postoperative complications in elderly patients with gastric cancer undergoing gastrectomy","volume":"32","author":"Kushiyama","year":"2018","journal-title":"In Vivo"},{"key":"B16","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12877-020-1501-8","article-title":"The geriatric nutrition risk index versus the mini-nutritional assessment short form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: A prospective cohort study","volume":"20","author":"Zhao","year":"2020","journal-title":"BMC Geriatr"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.06.030","article-title":"Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer","volume":"162","author":"Takahashi","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1186\/s12871-024-02874-2","article-title":"Association between the geriatric nutritional risk index and postoperative delirium in gastric surgery patients: An analysis of the MIMIC-IV database","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14343","article-title":"Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery","volume":"30","author":"Chen","year":"2024","journal-title":"CNS Neurosci Ther"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.86268","article-title":"Usefulness of the geriatric nutritional risk index (GNRI) as a predictor of postoperative complications after colorectal cancer surgery","volume":"17","author":"Nakamura","year":"2025","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.22603\/ssrr.2025-0016","article-title":"Impact of nutritional risk on complications and recovery in the older people: A geriatric nutritional risk index-based study","volume":"9","author":"Ode","year":"2025","journal-title":"Spine Surg Relat Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.14080","article-title":"The geriatric nutritional risk index: A key indicator of perioperative outcome in oldest-old patients with colorectal cancer","volume":"39","author":"Teraishi","year":"2025","journal-title":"In Vivo"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.21037\/tcr-2025-1140","article-title":"The association of geriatric nutritional risk and perioperative anesthesia-related adverse reactions in elderly patients with colorectal cancer-a prospective study","volume":"14","author":"You","year":"2025","journal-title":"Transl Cancer Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13243266","article-title":"The prognostic implications of the geriatric nutritional risk index in patients with prostate cancer: A single-center retrospective cohort study","volume":"13","author":"Zhou","year":"2025","journal-title":"Healthcare (Basel)"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1626383","article-title":"Preoperative geriatric nutritional risk index as a predictor of postoperative delirium in revision arthroplasty: A 10-year retrospective cohort study","volume":"12","author":"Chen","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1669159","article-title":"Comparative predictive value of preoperative GNRI, PNI, and CONUT for postoperative delirium in geriatric abdominal surgery patients admitted to the ICU","volume":"12","author":"Chen","year":"2025","journal-title":"Front Nutr"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.31222\/osf.io\/gwdhk","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B28","article-title":"Cochrane handbook for systematic reviews of interventions version 6.2","volume-title":"The Cochrane Collaboration","author":"Higgins","year":"2021"},{"key":"B29","unstructured":"The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses\n          \n          \n            \n              Wells\n              GA\n            \n            \n              Shea\n              B\n            \n            \n              O'Connell\n              D\n            \n            \n              Peterson\n              J\n            \n            \n              Welch\n              V\n            \n            \n              Losos\n              M\n            \n          \n          \n          2010"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.6.529-a","article-title":"What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes","volume":"280","author":"Zhang","year":"1998","journal-title":"JAMA"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1191\/026921699666884611","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"B32","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12874-020-00966-4","article-title":"Methodological tools and sensitivity analysis for assessing quality or risk of bias used in systematic reviews published in the high-impact anesthesiology journals","volume":"20","author":"Maru\u0161i\u0107","year":"2020","journal-title":"BMC Med Res Methodol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4020-8486-7_10","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2024.45.9.20240216","article-title":"Geriatric nutritional risk index predicts postoperative delirium in elderly: A meta-analysis","volume":"45","author":"Xie","year":"2024","journal-title":"Saudi Med J"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/mco.0b013e3283186f59","article-title":"The geriatric nutritional risk index","volume":"12","author":"Cereda","year":"2009","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: Pathogenesis and clinical significance","volume":"43","author":"Soeters","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3892\/mmr.2023.13147","article-title":"Albumin, an interesting and functionally diverse protein, varies from 'native' to 'effective' (Review)","volume":"29","author":"Wu","year":"2024","journal-title":"Mol Med Rep"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.cccb.2024.100312","article-title":"Blood-brain barrier disruption measured by albumin index correlates with inflammatory fluid biomarkers","volume":"43","author":"Hillmer","year":"2023","journal-title":"J Cereb Blood Flow Metab"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-5949.2010.00173.x","article-title":"The role of inflammation in the pathogenesis of delirium and dementia in older adults: A review","volume":"17","author":"Simone","year":"2011","journal-title":"CNS Neurosci Ther"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3390\/nu15061505","article-title":"Associations between body mass index and probable sarcopenia in community-dwelling older adults","volume":"15","author":"Curtis","year":"2023","journal-title":"Nutrients"},{"key":"B42","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1186\/s12877-025-06197-w","article-title":"The relationship between frailty, BMI, and mortality in older adults: Results from the CLHLS","volume":"25","author":"Gao","year":"2025","journal-title":"BMC Geriatr"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3390\/clinpract13060138","article-title":"Evaluating nutritional risk factors for delirium in intensive-care-unit patients: Present insights and prospects for future research","volume":"13","author":"Piccirillo","year":"2023","journal-title":"Clin Pract"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.bionps.2023.100064","article-title":"Biomarkers of delirium and relation to dementia among the elderly in the intensive care unit: A narrative review","volume":"8","author":"El Sheikh","year":"2023","journal-title":"biomark Neuropsychiatr"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000046021","article-title":"Analysis of risk factors and development of a predictive model for postoperative delirium in elderly patients undergoing cardiac surgery with general anesthesia","volume":"104","author":"Xu","year":"2025","journal-title":"Med (Baltimore)"},{"key":"B46","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/s41398-024-02762-w","article-title":"Prediction models for postoperative delirium in elderly patients with machine-learning algorithms and SHapley additive explanations","volume":"14","author":"Song","year":"2024","journal-title":"Transl Psychiatry"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3390\/nu17223574","article-title":"Associations between frailty, sarcopenia, and nutritional status in older adults living in nursing homes","volume":"17","author":"\u0130ncedal Irgat","year":"2025","journal-title":"Nutrients"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0b013e3181de24bc","article-title":"Identifying and avoiding bias in research","volume":"126","author":"Pannucci","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.68492","article-title":"Postoperative delirium and neurocognitive disorders: A comprehensive review of pathophysiology, risk factors, and management strategies","volume":"16","author":"Paunikar","year":"2024","journal-title":"Cureus"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1826824\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:37:51Z","timestamp":1776922671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1826824\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":49,"alternative-id":["10.3389\/fpsyt.2026.1826824"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1826824","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"article-number":"1826824"}}