Chronic limb-threatening ischemia (CLTI) is an advanced form of lower extremity artery disease (LEAD) that manifests as rest pain or minor or major tissue loss. It is associated with 1-year mortality rate of 25-35% and 1-year of amputation up to 30%. The relationship between nutritional status and CLTI outcomes has generated increasing attention in recent years. The Geriatric Nutritional Risk Index (GNRI) has emerged as a valuable tool for assessing nutritional status and predicting outcomes in various cardiovascular status. Previous studies have demonstrated that GNRI is an independent predictor of adverse events in CLTI patients after endovascular therapy (EVT). Specially, lower GNRI scores have been associated with higher rates of major adverse cardiovascular and limb events, all-cause mortality, and amputation in CLTI patients. While the link between CLTI and GNRI is well-established, less attention has been paid to the role of GNRI in earlier stages of LEAD, particularly in patients with claudication. Therefore, we investigated the association between GNRI and prognosis in patients with claudication after EVT.

This study was a single-center, retrospective analysis. Between April 2010 and December 2022, consecutive 142 patients underwent the first EVT for LEAD at Narita Memorial Hospital, Toyohashi, Japan. Of these cases, 127 patients were evaluated (follow up rate 87.6%). The patients were divided into two groups based on the median GNRI. The primary endpoint was all-cause death, and secondary endpoint was major amputation after EVT. 

The median follow-up period was 47.5 months (interquartile range, 34.0-61.8 months) in this study. During the follow-up, 76 patients died, and 14 patients underwent major amputation after EVT in overall population. All-cause death and major amputation rates were significantly higher in the lower GNRI group in overall population (log rank p < 0.01). In addition, cardiovascular death and sepsis death were significantly higher in the lower GMRI group (log rank p < 0.01, respectively). The claudication group was 55 patients and the CLTI group was 72 patients, respectively. In the claudication group, all-cause mortality was significantly higher in the lower GNRI group and major amputation tends to be higher in the lower GNRI group after EVT (log rank p < 0.01, log rank p = 0.29, respectively). In the CLTI group, all-cause mortality and major amputation were significantly higher in the lower GNRI group after EVT (log rank < 0.01, log rank p < 0.05, respectively). 

The GNRI was independently associated with all-cause mortality and major amputation in LEAD patients after EVT. Moreover, in the claudication group, all-cause mortality was significantly higher in the lower GNRI group (log rank p < 0.01).