Systematic Review to Assess the Impact of Geriatric Nutritional Risk Index (GNRI) Score on Outcomes of Lower Extremity Endovascular and Open Revascularization Operations for Treatment of Peripheral Artery Disease

Background Clinical decision making for management of patients with Critical Limb Threatening Ischemia involves patient risk assessment, limb condition, and anatomic pattern of the peripheral arterial disease (PAD). Malnutrition can be used as a tool to aid in patient risk assessment. Many studies have assessed the nutritional status by using various indexes, like Geriatric Nutritional Risk Index (GNRI), and analyzed its impact on postoperative outcomes. The aim of this systematic review is to assess the correlation between GNRI scores and surgical outcomes in patients undergoing lower extremity revascularization (LER) for PAD. Methods The systematic review was conducted using 2 literature databases, PubMed and Scopus, to find all relevant publications. A standardized data search was performed in June 2024 based on a standard framework designed to collect literature from a target patient population, intervention, comparator, and outcomes of interest (PICO). The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After collecting and analyzing all included studies, the risk of bias was investigated using the Risk of Bias in Nonrandomized Studies of Interventions tool. Results The search strategy generated based on our PICO framework yielded a total of 345 papers after duplicate removal. After title and abstract screening of these papers, an additional 320 studies were excluded. Fourteen more studies were excluded during full text screening. Eleven studies met the inclusion criteria and were subsequently included in this review. The studies were examined and assessed for the relationship between GNRI scores and postoperative outcomes after LER for PAD. Out of the 11 studies, 4 evaluated endovascular interventions, 3 focused on open bypass procedures, and 4 studies included outcomes after both open and endovascular lower extremity procedures in relation to GNRI. The results of these studies showed an association between poor nutritional status, as indicated by low GNRI scores, with poor surgical outcomes. Some of the key findings were higher mortality rates and increased major amputation rates among patients with low GNRI scores. This could indicate that the severity of PAD is exacerbated in patients with poor nutritional status, potentially limiting their postoperative recovery. In addition, patients with low GNRI scores had decreased amputation-free survival, highlighting the importance of preoperative nutritional assessment in managing PAD patients. Finally, the risk of bias assessment revealed an overall moderate bias between all the studies. Conclusion Patients with low GNRI scores are at increased risk of poor outcomes following LER surgery. Risk stratification based on GNRI score calculation can be beneficial in identifying high-risk patients and reducing the risk of unwanted events in patients undergoing revascularization.