Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 000, Number 000, October 2026, pages 000-000

Prognostic Value of the Geriatric Nutritional Risk Index and Controlling Nutritional Status Score in Patients Aged ≥ 75 Years With Heart Failure With Preserved Ejection Fraction

↓ Figure 1. Patient flowchart. HFpEF: heart failure with preserved ejection fraction; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index.

↓ Figure 2. Kaplan–Meier survival curves. (a) Survival probability stratified by CONUT score. (b) Cumulative hazard stratified by CONUT score. (c) Survival probability stratified by GNRI score. (d) Cumulative hazard stratified by GNRI score. CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index.

↓ Figure 3. Receiver operating characteristic (ROC) curve of CONUT score, GNRI score, and the combined scores. AUC: area under the curve; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index.

↓ **Table 1.** Clinical Data of Patients Stratified by CONUT Score and GNRI Score
Characteristic	CONUT score	P value
General situation
Hospitalization days (days)	18 (10, 33)	29 (17, 41)	31 (20, 47)^a	46 (22, 55)^a	0.011
Age (years)	93 (91, 95)	92 (90, 94)	92 (91, 94)	94 (92, 96)	0.318
Male (%)	20 (95.2)	67 (91.8)	85 (94.4)	10 (83.3)	0.413
Heart rate (beats/min)	70 (66, 78)	72 (66, 81)	73 (65, 80)	78 (75, 89)	0.078
Systolic blood pressure (mm Hg)	132 (120, 158)	132 (120, 144)	132 (120, 145)	123 (115, 145)	0.560
Diastolic blood pressure (mm Hg)	71 (62, 80)	71 (61, 78)	68 (62, 76)	73 (63, 77)	0.452
BMI (kg/m²)	22.0 (21.5, 24.6)	23.0 (22.5, 25.9)	22.4 (20.8, 24.2)	24.5 (22.0, 24.7)	0.289
CONUT score	1 (0, 1)	3 (2.5, 4)^a	6 (5, 7)^{a, b}	9 (9, 9)^{a, b, c}	< 0.001
GNRI score	98.4 (96.1, 102.6)	96.5 (91.6, 105.0)^a	88.0 (83.9, 91.4)^{a, b}	82.1 (76.5, 87.1)^{a, b, c}	< 0.001
Laboratory data
Albumin (g/L)	38.4 ± 1.8	36.2 ± 4.0^a	31.0 ± 3.0^{a, b}	26.5 ± 2.6^{a, b, c}	< 0.001
Lymphocyte (× 10⁹/L)	1.8 (1.7, 2.1)	1.5 (1.2, 1.9)^a	1.0 (0.7, 1.2)^{a, b}	0.7 (0.6, 1.4)^{a, b}	< 0.001
Cholesterol (mmol/L)	4.6 (3.9, 5.5)	3.7 (2.9, 4.0)^a	3.3 (2.9, 3.8)^a	2.6 (2.5, 3.3)^{a, b, c}	< 0.001
Hemoglobin (g/L)	124 (116, 131)	120 (100.5, 130)	107 (96.5, 120)^{a, b}	99 (85.3, 121)^{a, b}	< 0.001
C-reactive protein (mg/L)	0.5 (0.5, 3.5)	2.2 (0.5, 15.1)	14.5 (3.7, 52.2)^{a, b}	13.6 (3.3, 50.6)^{a, b}	< 0.001
Urea nitrogen (mmol/L)	8 (6.7, 12.5)	10.1 (7.6, 14)	9.2 (7.1, 13.6)	10.0 (6.7, 14)	0.419
Creatinine (µmol/L)	101.6 (80.2, 124.5)	110.4 (80.8, 174.5)	102.2 (79.6, 141.1)	100.8 (63.8, 135.4)	0.535
Prealbumin (mg/L)	229.2 ± 43.6	209.3 ± 51.6	185.3 ± 58.5^{a, b}	150.5 ± 80.1^{a, b}	<0.001
Triglyceride (mmol/L)	1.1 (0.9, 1.3)	1.0 (0.7, 1.3)	0.9 (0.6, 1.3)	0.7 (0.6, 1.1)	0.173
LDL-C (mmol/L)	2.4 (2.0, 3.0)	1.7 (1.3, 2.1)^a	1.6 (1.3, 2.0)^a	1.4 (1.1, 1.7)^{a, b, c}	< 0.001
HDL-C (mmol/L)	1.2 (1.0, 1.5)	1.0 (0.8, 1.2)^a	0.9 (0.8, 1.2)^a	0.9 (0.8, 1.1)^a	0.003
PCT (µg/L)	0.05 (0.03, 0.11)	0.07 (0.04, 0.11)	0.11 (0.06, 0.22)^{a, b}	0.10 (0.06, 0.27)^a	< 0.001
IL-6 (ng/L)	7.5 (3.7, 12.3)	10.7 (7.5, 20.9)^a	18.9 (8.9, 37.8)^{a, b}	36.6 (13.3, 56.7)^{a, b}	< 0.001
NT-proBNP (pmol/L)	230.8 (143.8, 341.5)	269.5 (195, 392.9)	329.0 (225.5, 519.3)^{a, b}	398.4 (242.8, 600.8)^a	0.012
TSAT (%)	0.31 (0.24, 0.40)	0.26 (0.19, 0.34)	0.24 (0.18, 0.33)^a	0.20 (0.15, 0.27)^a	0.041
SF (µmol/L)	13.2 (11.6, 18.8)	11.6 (8.0, 13.8)^a	9.1 (6.5, 11.5)^{a, b}	8.1 (5.4, 10.3)^{a, b}	< 0.001
UIBC (µmol/L)	31.8 (27.5, 38.1)	30.4 (23.5, 37.5)	25.5 (20.6, 32.1)^{a, b}	28.4 (22.5, 32.9)	0.009
TIBC (µmol/L)	48.7 (42.9, 52.3)	42.9 (34.2, 51.1)^a	35.7 (30.3, 41.4)^{a, b}	36.1 (30.8, 41.9)^a	< 0.001
Echocardiographic data
LVEF (%)	63 (58.5, 69)	60 (57, 64)	61 (56, 66.3)	59.5 (55.8, 64)	0.180
AOD (mm)	34 (32, 37)	34 (32, 37.5)	35 (32.8, 38)	34.5 (33.3, 36.8)	0.797
LAD (mm)	43 (37.5, 45)	44 (38.5, 48.5)	41 (37, 45)	41 (39.3, 44.8)	0.072
LVDD (mm)	47 (42.5, 49.5)	47 (43.5, 50.5)	47 (44, 51)	45 (42.3, 46.8)	0.167
RVD (mm)	24 (21, 26)	25 (23, 26)	25 (22, 26)	24 (22.3, 26.8)	0.417
IVS (mm)	11 (10, 12)	11 (10, 12)	11 (10, 12)	11 (11, 13)	0.155
LVPW (mm)	10 (9, 11)	10 (10, 11)	10 (10, 11)	11 (10, 13)	0.284
Comorbidity
Hypertension (%)	15 (71.4)	59 (80.8)	70 (77.8)	9 (75)	0.776
Diabetes (%)	5 (23.8)	32 (43.8)	40 (44.4)	5 (41.7)	0.373
Coronary heart disease (%)	20 (95.2)	70 (95.9)	85 (94.4)	12 (100)	0.940
COPD (%)	2 (9.5)	29 (39.7)^a	31 (34.3)^a	5 (41.7)^a	0.055
Chronic renal insufficiency (%)	8 (38.1)	33 (45.2)	41 (45.6)	5 (41.7)	0.931
Anemia (%)	2 (9.5)	28 (38.4)^a	54 (60.0)^{a, b}	7 (58.3)^a	< 0.001
Atrial fibrillation (%)	10 (47.6)	40 (54.8)	28 (31.1)^b	7 (58.3)	0.014
Medications
Diuretic (%)	10 (47.6)	48 (65.8)	55 (61.1)	9 (75)	0.366
ACEI/ARB/ARNI (%)	11 (52.4)	27 (37.0)	16 (17.8)^{a, b}	3 (25)	0.003
β-Blocker (%)	11 (52.4)	45 (61.6)	37 (41.1)^b	7 (58.3)	0.069
Spironolactone (%)	7 (33.3)	34 (46.6)	34 (37.8)	4 (33.3)	0.552
SGLT2i (%)	2 (9.5)	6 (8.2)	1 (1.1)	0 (0)	0.064
Cardiotonic (%)	0 (0)	6 (8.2)	6 (6.7)	4 (33.3)^{a, b, c}	0.024
Iron agents (%)	0 (0)	11 (15.1)	12 (13.3)	3 (25)	0.128
Nutrition support (%)	4 (19.0)	19 (26.0)	38 (42.2)^{a, b}	9 (75)^{a, b, c}	0.002
^aP values < 0.05 vs. normal malnutrition or no risk of malnutrition. ^bP values < 0.05 vs. mild malnutrition or low malnutrition risk. ^cP values < 0.05 vs. moderate malnutrition or medium malnutrition risk. BMI: body mass index; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; PCT: procalcitonin; IL-6: interleukin-6; NT-proBNP: N-terminal pro-B-type natriuretic peptide; TSAT: transferrin saturation; SF: serum ferritin; UIBC: unsaturated iron-binding capacity; TIBC: total iron-binding capacity; LVEF: left ventricular ejection fraction; AOD: aortic diameter; LAD: left atrial diameter; LVDD: left ventricular diastolic diameter; RVD: right ventricular diameter; IVS: interventricular septum; LVPW: left ventricular posterior wall; COPD: chronic obstructive pulmonary disease; ACEI: angiotensin-converting-enzyme inhibitor; ARB: angiotensin II receptor blocker; ARNI: angiotensin-receptor-neprilysin inhibitor; SGLT2i: sodium-dependent glucose transporters 2 inhibitor.
General situation
Hospitalization days (days)	27 (16, 40)	28.5 (16.8, 39.3)	29 (18, 43.3)	42 (25, 56)^{a, b, c}	0.037
Age (years)	92 (90, 94)	92.5 (90.5, 94)	93 (90, 94.25)	94 (91, 97)	0.149
Male (%)	53 (93.0)	35 (92.1)	75 (96.2)	19 (82.6)	0.175
Heart rate (beats/min)	73 (68, 79.5)	70 (63.5, 83.5)	73 (65, 79.25)	77 (70, 84)	0.559
Systolic blood pressure (mm Hg)	134 (119.5, 150)	138.5 (121, 150)	126 (120, 144)	135 (115, 140)	0.515
Diastolic blood pressure (mm Hg)	70 (63, 79)	70 (61.75, 77)	68 (61.75, 76)	70 (63, 79)	0.36
BMI (kg/m²)	25.9 (23.7, 28.1)	22.7 (21.3, 24.4)^a	22 (20.6, 22.9)^{a, b}	20.3 (19.0, 22.1)^{a, b}	< 0.001
CONUT score	3 (2, 4)	4 (2, 5)	6 (4, 7)^{a, b}	7 (6, 9)^{a, b, c}	< 0.001
GNRI score	102.6 (99.6, 106.7)	94.5 (93.1, 96.3)^a	87.8 (86.2, 89.8)^{a, b}	78.7 (76.3, 80.5)^{a, b, c}	< 0.001
Laboratory data
Albumin (g/L)	37.63 ± 4.34	34.92 ± 0.66^a	31.63 ± 2.49^{a, b}	26.78 ± 2.44^{a, b, c}	< 0.001
Lymphocyte (× 10⁹/L)	1.51 (1.10, 1.82)	1.40 (0.905, 1.835)	1.1 (0.735, 1.54)^{a, b}	1.11 (0.66, 1.56)^{a, b}	0.001
Cholesterol (mmol/L)	3.39 (2.70, 4.00)	3.75 (3.33, 4.49)	3.25 (2.91, 3.8525)	3.63 (3.16, 4.05)	0.067
Hemoglobin (g/L)	118 (99.5, 135.5)	117 (106.5, 126.25)	112 (100.75, 123.25)	99 (87, 109)^{a, b, c}	0.004
C-reactive protein (mg/L)	2.6 (0.5, 14.25)	2.35 (0.5, 16.15)	12.1 (2, 44.325)^{a, b}	18.2 (7.5, 55.1)^{a, b}	< 0.001
Urea nitrogen (mmol/L)	10.2 (7.65, 13.9)	9.4 (7.2, 12.425)	8.9 (6.8, 13.375)	9.5 (7.2, 14)	0.454
Creatinine (µmol/L)	122.7 (81.4, 176.9)	96.9 (78.4, 136.4)	98.9 (76.7, 135.9)	102.9 (78.4, 125.8)	0.113
Prealbumin (mg/L)	221.79 ± 56.29	210.03 ± 51.45	184.5 ± 49.98^{a, b}	149 ± 73.7^{a, b}	< 0.001
Triglyceride (mmol/L)	1.02 (0.715, 1.32)	1.03 (0.675, 1.6325)	0.89 (0.66, 1.28)	0.79 (0.61, 1.21)	0.419
LDL-C (mmol/L)	1.63 (1.26, 2.28)	1.82 (1.21, 2.28)	1.68 (1.37, 2.17)	1.81 (1.42, 2.13)	0.916
HDL-C (mmol/L)	0.96 (0.79, 1.145)	1.15 (0.93, 1.47)^a	0.97 (0.81, 1.14)^b	1 (0.85, 1.33)	0.023
PCT (µg/L)	0.08 (0.04, 0.12)	0.05 (0.04, 0.11)	0.10 (0.05,0.21)^{a, b}	0.16 (0.10, 0.39)^{a, b, c}	< 0.001
IL-6 (ng/L)	10.65 (5.77, 20.14)	8.94 (5.62, 17.67)	17.74 (9.91, 37.84)^{a, b}	25.6 (13.0, 52.23)^{a, b}	< 0.001
NT-proBNP (pmol/L)	249 (208.5, 380.8)	278.5 (170.8, 373.4)	316.9 (209.9, 500.7)	361.4 (270.9, 724.4)^{a, b}	0.012
TSAT (%)	0.27 (0.20, 0.34)	0.26 (0.23, 0.35)	0.27 (0.18, 0.35)	0.22 (0.14, 0.26)^{a, b, c}	0.033
SF (µmol/L)	11.6 (8.4, 15.8)	12.4 (8.65, 13.525)	9.6 (6.75, 12.3)^a	6.9 (5.4, 9)^{a, b, c}	< 0.001
UIBC (µmol/L)	32.2 (25.95, 38.4)	30.35 (23.5, 37.93)	25.75 (20.18, 31.33)^{a, b}	26.9 (22.4, 32.3)^a	0.001
TIBC (µmol/L)	45.1 (37.2, 51.35)	40.45 (34.85, 51)	35.85 (30.28, 40.43)^{a, b}	33.8 (28.2, 42.2)^{a, b}	< 0.001
Echocardiographic data
LVEF (%)	59 (56, 63.5)	61 (58, 64)	61 (57, 66.3)	60 (57, 66)	0.558
AOD (mm)	35 (42, 50)	35 (32, 37.25)	34 (31.75, 38)	34 (33, 36)	0.653
LAD (mm)	45 (42, 50)	43 (39.75, 45.5)^a	41 (37, 44)^a	39 (35, 41)^{a, b}	< 0.001
LVDD (mm)	48 (45, 50)	49.5 (44.75, 53)	45 (43, 49)^{a, b}	46 (42, 49)^{a, b}	0.002
RVD (mm)	25 (23, 26)	24 (22.5, 26)	25 (22, 27)	23 (18, 26)	0.102
IVS (mm)	11 (10, 12)	10 (10, 11)^a	11 (10, 12)^a	11 (10, 12)	0.025
LVPW (mm)	11 (10, 12)	10 (10, 11)^a	10 (9, 11)^a	10 (10, 11)	0.020
Comorbidity
Hypertension (%)	47 (82.5)	28 (73.7)	61 (78.2)	17 (73.9)	0.729
Diabetes (%)	27 (47.4)	16 (42.1)	32 (41.0)	7 (30.4)	0.579
Coronary heart disease (%)	55 (96.5)	37 (97.4)	75 (96.2)	20 (87.0)	0.264
COPD (%)	22 (38.6)	13 (34.2)	24 (30.8)	8 (34.8)	0.825
Chronic renal insufficiency (%)	32 (56.1)	12 (31.6)	33 (42.3)	10 (43.5)	0.119
Anemia (%)	24 (42.1)	13 (34.2)	37 (46.4)	17 (73.9)^{a, b, c}	0.021
Atrial fibrillation (%)	34 (59.6)	14 (36.8)^a	31 (39.7)^a	6 (26.1)^a	0.018
Medications
Diuretic (%)	37 (64.9)	19 (50.0)	49 (62.8)	17 (73.9)	0.268
ACEI/ARB/ARNI (%)	26 (45.6)	9 (23.7)^a	21 (26.9)	1 (4.3)^{a, b, c}	0.002
β-Blocker (%)	35 (61.4)	17 (44.7)	35 (44.9)	13 (56.5)	0.211
Spironolactone (%)	27 (47.4)	10 (26.3)	32 (41.0)	10 (43.5)	0.223
SGLT2i (%)	3 (5.3)	4 (10.5)	2 (2.6)	0 (0)	0.217
Cardiotonic (%)	6 (10.5)	1 (2.6)	5 (6.4)	4 (17.4)	0.176
Iron agents (%)	5 (8.8)	6 (15.8)	10 (12.8)	5 (21.7)	0.447
Nutrition support (%)	10 (17.5)	11 (28.9)	31 (39.7)	18 (78.3)^{a, b, c}	< 0.001

↓ Table 1. Clinical Data of Patients Stratified by CONUT Score and GNRI Score

Characteristic

CONUT score

P value

Normal (0–1, n = 21)

Mild malnutrition (2–4, n = 73)

Moderate malnutrition (5–8, n = 90)

Severe malnutrition (9–12, n = 12)

General situation

Hospitalization days (days)

18 (10, 33)

29 (17, 41)

31 (20, 47)^a

46 (22, 55)^a

0.011

Age (years)

93 (91, 95)

92 (90, 94)

92 (91, 94)

94 (92, 96)

0.318

Male (%)

20 (95.2)

67 (91.8)

85 (94.4)

10 (83.3)

0.413

Heart rate (beats/min)

70 (66, 78)

72 (66, 81)

73 (65, 80)

78 (75, 89)

0.078

Systolic blood pressure (mm Hg)

132 (120, 158)

132 (120, 144)

132 (120, 145)

123 (115, 145)

0.560

Diastolic blood pressure (mm Hg)

71 (62, 80)

71 (61, 78)

68 (62, 76)

73 (63, 77)

0.452

BMI (kg/m²)

22.0 (21.5, 24.6)

23.0 (22.5, 25.9)

22.4 (20.8, 24.2)

24.5 (22.0, 24.7)

0.289

CONUT score

1 (0, 1)

3 (2.5, 4)^a

6 (5, 7)^{a, b}

9 (9, 9)^{a, b, c}

< 0.001

GNRI score

98.4 (96.1, 102.6)

96.5 (91.6, 105.0)^a

88.0 (83.9, 91.4)^{a, b}

82.1 (76.5, 87.1)^{a, b, c}

< 0.001

Laboratory data

Albumin (g/L)

38.4 ± 1.8

36.2 ± 4.0^a

31.0 ± 3.0^{a, b}

26.5 ± 2.6^{a, b, c}

< 0.001

Lymphocyte (× 10⁹/L)

1.8 (1.7, 2.1)

1.5 (1.2, 1.9)^a

1.0 (0.7, 1.2)^{a, b}

0.7 (0.6, 1.4)^{a, b}

< 0.001

Cholesterol (mmol/L)

4.6 (3.9, 5.5)

3.7 (2.9, 4.0)^a

3.3 (2.9, 3.8)^a

2.6 (2.5, 3.3)^{a, b, c}

< 0.001

Hemoglobin (g/L)

124 (116, 131)

120 (100.5, 130)

107 (96.5, 120)^{a, b}

99 (85.3, 121)^{a, b}

< 0.001

C-reactive protein (mg/L)

0.5 (0.5, 3.5)

2.2 (0.5, 15.1)

14.5 (3.7, 52.2)^{a, b}

13.6 (3.3, 50.6)^{a, b}

< 0.001

Urea nitrogen (mmol/L)

8 (6.7, 12.5)

10.1 (7.6, 14)

9.2 (7.1, 13.6)

10.0 (6.7, 14)

0.419

Creatinine (µmol/L)

101.6 (80.2, 124.5)

110.4 (80.8, 174.5)

102.2 (79.6, 141.1)

100.8 (63.8, 135.4)

0.535

Prealbumin (mg/L)

229.2 ± 43.6

209.3 ± 51.6

185.3 ± 58.5^{a, b}

150.5 ± 80.1^{a, b}

<0.001

Triglyceride (mmol/L)

1.1 (0.9, 1.3)

1.0 (0.7, 1.3)

0.9 (0.6, 1.3)

0.7 (0.6, 1.1)

0.173

LDL-C (mmol/L)

2.4 (2.0, 3.0)

1.7 (1.3, 2.1)^a

1.6 (1.3, 2.0)^a

1.4 (1.1, 1.7)^{a, b, c}

< 0.001

HDL-C (mmol/L)

1.2 (1.0, 1.5)

1.0 (0.8, 1.2)^a

0.9 (0.8, 1.2)^a

0.9 (0.8, 1.1)^a

0.003

PCT (µg/L)

0.05 (0.03, 0.11)

0.07 (0.04, 0.11)

0.11 (0.06, 0.22)^{a, b}

0.10 (0.06, 0.27)^a

< 0.001

IL-6 (ng/L)

7.5 (3.7, 12.3)

10.7 (7.5, 20.9)^a

18.9 (8.9, 37.8)^{a, b}

36.6 (13.3, 56.7)^{a, b}

< 0.001

NT-proBNP (pmol/L)

230.8 (143.8, 341.5)

269.5 (195, 392.9)

329.0 (225.5, 519.3)^{a, b}

398.4 (242.8, 600.8)^a

0.012

TSAT (%)

0.31 (0.24, 0.40)

0.26 (0.19, 0.34)

0.24 (0.18, 0.33)^a

0.20 (0.15, 0.27)^a

0.041

SF (µmol/L)

13.2 (11.6, 18.8)

11.6 (8.0, 13.8)^a

9.1 (6.5, 11.5)^{a, b}

8.1 (5.4, 10.3)^{a, b}

< 0.001

UIBC (µmol/L)

31.8 (27.5, 38.1)

30.4 (23.5, 37.5)

25.5 (20.6, 32.1)^{a, b}

28.4 (22.5, 32.9)

0.009

TIBC (µmol/L)

48.7 (42.9, 52.3)

42.9 (34.2, 51.1)^a

35.7 (30.3, 41.4)^{a, b}

36.1 (30.8, 41.9)^a

< 0.001

Echocardiographic data

LVEF (%)

63 (58.5, 69)

60 (57, 64)

61 (56, 66.3)

59.5 (55.8, 64)

0.180

AOD (mm)

34 (32, 37)

34 (32, 37.5)

35 (32.8, 38)

34.5 (33.3, 36.8)

0.797

LAD (mm)

43 (37.5, 45)

44 (38.5, 48.5)

41 (37, 45)

41 (39.3, 44.8)

0.072

LVDD (mm)

47 (42.5, 49.5)

47 (43.5, 50.5)

47 (44, 51)

45 (42.3, 46.8)

0.167

RVD (mm)

24 (21, 26)

25 (23, 26)

25 (22, 26)

24 (22.3, 26.8)

0.417

IVS (mm)

11 (10, 12)

11 (11, 13)

0.155

LVPW (mm)

10 (9, 11)

10 (10, 11)

11 (10, 13)

0.284

Comorbidity

Hypertension (%)

15 (71.4)

59 (80.8)

70 (77.8)

9 (75)

0.776

Diabetes (%)

5 (23.8)

32 (43.8)

40 (44.4)

5 (41.7)

0.373

Coronary heart disease (%)

20 (95.2)

70 (95.9)

85 (94.4)

12 (100)

0.940

COPD (%)

2 (9.5)

29 (39.7)^a

31 (34.3)^a

5 (41.7)^a

0.055

Chronic renal insufficiency (%)

8 (38.1)

33 (45.2)

41 (45.6)

5 (41.7)

0.931

Anemia (%)

2 (9.5)

28 (38.4)^a

54 (60.0)^{a, b}

7 (58.3)^a

< 0.001

Atrial fibrillation (%)

10 (47.6)

40 (54.8)

28 (31.1)^b

7 (58.3)

0.014

Medications

Diuretic (%)

10 (47.6)

48 (65.8)

55 (61.1)

9 (75)

0.366

ACEI/ARB/ARNI (%)

11 (52.4)

27 (37.0)

16 (17.8)^{a, b}

3 (25)

0.003

β-Blocker (%)

11 (52.4)

45 (61.6)

37 (41.1)^b

7 (58.3)

0.069

Spironolactone (%)

7 (33.3)

34 (46.6)

34 (37.8)

4 (33.3)

0.552

SGLT2i (%)

2 (9.5)

6 (8.2)

1 (1.1)

0 (0)

0.064

Cardiotonic (%)

0 (0)

6 (8.2)

6 (6.7)

4 (33.3)^{a, b, c}

0.024

Iron agents (%)

0 (0)

11 (15.1)

12 (13.3)

3 (25)

0.128

Nutrition support (%)

4 (19.0)

19 (26.0)

38 (42.2)^{a, b}

9 (75)^{a, b, c}

0.002

GNRI score

Normal (> 98, n = 57)

Low malnutrition risk (92 ≤ GNRI ≤ 98, n = 38)

Medium malnutrition risk (82 ≤ GNRI < 92, n = 78)

High malnutrition risk (< 82, n = 23)

^aP values < 0.05 vs. normal malnutrition or no risk of malnutrition. ^bP values < 0.05 vs. mild malnutrition or low malnutrition risk. ^cP values < 0.05 vs. moderate malnutrition or medium malnutrition risk. BMI: body mass index; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; PCT: procalcitonin; IL-6: interleukin-6; NT-proBNP: N-terminal pro-B-type natriuretic peptide; TSAT: transferrin saturation; SF: serum ferritin; UIBC: unsaturated iron-binding capacity; TIBC: total iron-binding capacity; LVEF: left ventricular ejection fraction; AOD: aortic diameter; LAD: left atrial diameter; LVDD: left ventricular diastolic diameter; RVD: right ventricular diameter; IVS: interventricular septum; LVPW: left ventricular posterior wall; COPD: chronic obstructive pulmonary disease; ACEI: angiotensin-converting-enzyme inhibitor; ARB: angiotensin II receptor blocker; ARNI: angiotensin-receptor-neprilysin inhibitor; SGLT2i: sodium-dependent glucose transporters 2 inhibitor.

General situation

Hospitalization days (days)

27 (16, 40)

28.5 (16.8, 39.3)

29 (18, 43.3)

42 (25, 56)^{a, b, c}

0.037

Age (years)

92 (90, 94)

92.5 (90.5, 94)

93 (90, 94.25)

94 (91, 97)

0.149

Male (%)

53 (93.0)

35 (92.1)

75 (96.2)

19 (82.6)

0.175

Heart rate (beats/min)

73 (68, 79.5)

70 (63.5, 83.5)

73 (65, 79.25)

77 (70, 84)

0.559

Systolic blood pressure (mm Hg)

134 (119.5, 150)

138.5 (121, 150)

126 (120, 144)

135 (115, 140)

0.515

Diastolic blood pressure (mm Hg)

70 (63, 79)

70 (61.75, 77)

68 (61.75, 76)

70 (63, 79)

0.36

BMI (kg/m²)

25.9 (23.7, 28.1)

22.7 (21.3, 24.4)^a

22 (20.6, 22.9)^{a, b}

20.3 (19.0, 22.1)^{a, b}

< 0.001

CONUT score

3 (2, 4)

4 (2, 5)

6 (4, 7)^{a, b}

7 (6, 9)^{a, b, c}

< 0.001

GNRI score

102.6 (99.6, 106.7)

94.5 (93.1, 96.3)^a

87.8 (86.2, 89.8)^{a, b}

78.7 (76.3, 80.5)^{a, b, c}

< 0.001

Laboratory data

Albumin (g/L)

37.63 ± 4.34

34.92 ± 0.66^a

31.63 ± 2.49^{a, b}

26.78 ± 2.44^{a, b, c}

< 0.001

Lymphocyte (× 10⁹/L)

1.51 (1.10, 1.82)

1.40 (0.905, 1.835)

1.1 (0.735, 1.54)^{a, b}

1.11 (0.66, 1.56)^{a, b}

0.001

Cholesterol (mmol/L)

3.39 (2.70, 4.00)

3.75 (3.33, 4.49)

3.25 (2.91, 3.8525)

3.63 (3.16, 4.05)

0.067

Hemoglobin (g/L)

118 (99.5, 135.5)

117 (106.5, 126.25)

112 (100.75, 123.25)

99 (87, 109)^{a, b, c}

0.004

C-reactive protein (mg/L)

2.6 (0.5, 14.25)

2.35 (0.5, 16.15)

12.1 (2, 44.325)^{a, b}

18.2 (7.5, 55.1)^{a, b}

< 0.001

Urea nitrogen (mmol/L)

10.2 (7.65, 13.9)

9.4 (7.2, 12.425)

8.9 (6.8, 13.375)

9.5 (7.2, 14)

0.454

Creatinine (µmol/L)

122.7 (81.4, 176.9)

96.9 (78.4, 136.4)

98.9 (76.7, 135.9)

102.9 (78.4, 125.8)

0.113

Prealbumin (mg/L)

221.79 ± 56.29

210.03 ± 51.45

184.5 ± 49.98^{a, b}

149 ± 73.7^{a, b}

< 0.001

Triglyceride (mmol/L)

1.02 (0.715, 1.32)

1.03 (0.675, 1.6325)

0.89 (0.66, 1.28)

0.79 (0.61, 1.21)

0.419

LDL-C (mmol/L)

1.63 (1.26, 2.28)

1.82 (1.21, 2.28)

1.68 (1.37, 2.17)

1.81 (1.42, 2.13)

0.916

HDL-C (mmol/L)

0.96 (0.79, 1.145)

1.15 (0.93, 1.47)^a

0.97 (0.81, 1.14)^b

1 (0.85, 1.33)

0.023

PCT (µg/L)

0.08 (0.04, 0.12)

0.05 (0.04, 0.11)

0.10 (0.05,0.21)^{a, b}

0.16 (0.10, 0.39)^{a, b, c}

< 0.001

IL-6 (ng/L)

10.65 (5.77, 20.14)

8.94 (5.62, 17.67)

17.74 (9.91, 37.84)^{a, b}

25.6 (13.0, 52.23)^{a, b}

< 0.001

NT-proBNP (pmol/L)

249 (208.5, 380.8)

278.5 (170.8, 373.4)

316.9 (209.9, 500.7)

361.4 (270.9, 724.4)^{a, b}

0.012

TSAT (%)

0.27 (0.20, 0.34)

0.26 (0.23, 0.35)

0.27 (0.18, 0.35)

0.22 (0.14, 0.26)^{a, b, c}

0.033

SF (µmol/L)

11.6 (8.4, 15.8)

12.4 (8.65, 13.525)

9.6 (6.75, 12.3)^a

6.9 (5.4, 9)^{a, b, c}

< 0.001

UIBC (µmol/L)

32.2 (25.95, 38.4)

30.35 (23.5, 37.93)

25.75 (20.18, 31.33)^{a, b}

26.9 (22.4, 32.3)^a

0.001

TIBC (µmol/L)

45.1 (37.2, 51.35)

40.45 (34.85, 51)

35.85 (30.28, 40.43)^{a, b}

33.8 (28.2, 42.2)^{a, b}

< 0.001

Echocardiographic data

LVEF (%)

59 (56, 63.5)

61 (58, 64)

61 (57, 66.3)

60 (57, 66)

0.558

AOD (mm)

35 (42, 50)

35 (32, 37.25)

34 (31.75, 38)

34 (33, 36)

0.653

LAD (mm)

45 (42, 50)

43 (39.75, 45.5)^a

41 (37, 44)^a

39 (35, 41)^{a, b}

< 0.001

LVDD (mm)

48 (45, 50)

49.5 (44.75, 53)

45 (43, 49)^{a, b}

46 (42, 49)^{a, b}

0.002

RVD (mm)

25 (23, 26)

24 (22.5, 26)

25 (22, 27)

23 (18, 26)

0.102

IVS (mm)

11 (10, 12)

10 (10, 11)^a

11 (10, 12)^a

11 (10, 12)

0.025

LVPW (mm)

11 (10, 12)

10 (10, 11)^a

10 (9, 11)^a

10 (10, 11)

0.020

Comorbidity

Hypertension (%)

47 (82.5)

28 (73.7)

61 (78.2)

17 (73.9)

0.729

Diabetes (%)

27 (47.4)

16 (42.1)

32 (41.0)

7 (30.4)

0.579

Coronary heart disease (%)

55 (96.5)

37 (97.4)

75 (96.2)

20 (87.0)

0.264

COPD (%)

22 (38.6)

13 (34.2)

24 (30.8)

8 (34.8)

0.825

Chronic renal insufficiency (%)

32 (56.1)

12 (31.6)

33 (42.3)

10 (43.5)

0.119

Anemia (%)

24 (42.1)

13 (34.2)

37 (46.4)

17 (73.9)^{a, b, c}

0.021

Atrial fibrillation (%)

34 (59.6)

14 (36.8)^a

31 (39.7)^a

6 (26.1)^a

0.018

Medications

Diuretic (%)

37 (64.9)

19 (50.0)

49 (62.8)

17 (73.9)

0.268

ACEI/ARB/ARNI (%)

26 (45.6)

9 (23.7)^a

21 (26.9)

1 (4.3)^{a, b, c}

0.002

β-Blocker (%)

35 (61.4)

17 (44.7)

35 (44.9)

13 (56.5)

0.211

Spironolactone (%)

27 (47.4)

10 (26.3)

32 (41.0)

10 (43.5)

0.223

SGLT2i (%)

3 (5.3)

4 (10.5)

2 (2.6)

0 (0)

0.217

Cardiotonic (%)

6 (10.5)

1 (2.6)

5 (6.4)

4 (17.4)

0.176

Iron agents (%)

5 (8.8)

6 (15.8)

10 (12.8)

5 (21.7)

0.447

Nutrition support (%)

10 (17.5)

11 (28.9)

31 (39.7)

18 (78.3)^{a, b, c}

< 0.001

↓ **Table 2.** Prognosis Outcomes of Patients Stratified by CONUT and GNRI Score
Prognosis	CONUT score	P value
All-cause death (%)	1 (4.8)	13 (17.8)	57 (63.3)^{a, b}	12 (100)^{a, b}	< 0.001
Cardiovascular death (%)	0 (0.0)	4 (5.5)	14 (15.6)	3 (25.0)	0.019
All-cause readmission (%)	11 (52.4)	59 (80.8)^a	84 (93.3)^{a, b}	10 (83.3)^a	< 0.001
HF-related readmission (%)	2 (9.5)	23 (31.5)^a	55 (61.1)^{a, b}	10 (83.3)^{a, b}	< 0.001
^aP values < 0.05 vs. normal malnutrition or no risk of malnutrition. ^bP values < 0.05 vs. mild malnutrition or low malnutrition risk. ^cP values < 0.05 vs. moderate malnutrition or medium malnutrition risk. CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index.
All-cause death (%)	11 (19.3)	9 (23.7)	41 (52.6)^{a, b}	22 (95.7)^{a, b, c}	< 0.001
Cardiovascular death (%)	2 (3.5)	4 (10.5)	12 (15.4)	3 (13.0)	0.136
All-cause readmission (%)	43 (75.4)	29 (76.3)	71 (91.0)^a	21 (91.3)	0.038
HF-related readmission (%)	15 (26.3)	12 (31.6)	46 (59.0)^{a, b}	17 (73.9)^{a, b}	< 0.001

↓ Table 2. Prognosis Outcomes of Patients Stratified by CONUT and GNRI Score

Prognosis

CONUT score

P value

Normal (0–1, n = 21)

Mild malnutrition (2–4, n = 73)

Moderate malnutrition (5–8, n = 90)

Severe malnutrition (9–12, n = 12)

All-cause death (%)

1 (4.8)

13 (17.8)

57 (63.3)^{a, b}

12 (100)^{a, b}

< 0.001

Cardiovascular death (%)

0 (0.0)

4 (5.5)

14 (15.6)

3 (25.0)

0.019

All-cause readmission (%)

11 (52.4)

59 (80.8)^a

84 (93.3)^{a, b}

10 (83.3)^a

< 0.001

HF-related readmission (%)

2 (9.5)

23 (31.5)^a

55 (61.1)^{a, b}

10 (83.3)^{a, b}

< 0.001

Prognosis

GNRI score

P value

Normal (> 98, n = 57)

Low malnutrition risk (92 ≤ GNRI ≤ 98, n = 38)

Medium malnutrition risk (82 ≤ GNRI < 92, n = 78)

High malnutrition risk (< 82, n = 23)

All-cause death (%)

11 (19.3)

9 (23.7)

41 (52.6)^{a, b}

22 (95.7)^{a, b, c}

< 0.001

Cardiovascular death (%)

2 (3.5)

4 (10.5)

12 (15.4)

3 (13.0)

0.136

All-cause readmission (%)

43 (75.4)

29 (76.3)

71 (91.0)^a

21 (91.3)

0.038

HF-related readmission (%)

15 (26.3)

12 (31.6)

46 (59.0)^{a, b}

17 (73.9)^{a, b}

< 0.001

↓ **Table 3.** Multivariable Cox Proportional Hazards Regression for All-Cause Mortality in Elderly Patients With HFpEF
	P value	HR (95% CI)
CI: confidence interval; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index; HR: hazard ratio; NT-proBNP: N-terminal pro-B-type natriuretic peptide.
Age	0.318	1.208 (0.974–1.085)
Hypertension	0.130	0.671 (0.400–1.125)
Diabetes	0.124	1.444 (0.904–2.307)
Chronic renal insufficiency	0.283	1.288 (0.812–2.042)
GNRI score	0.043	0.962 (0.927–0.999)
CONUT score	0.001	1.366 (1.181–1.579)
NT-proBNP	0.017	1.000 (1.000–1.001)

↓ Table 3. Multivariable Cox Proportional Hazards Regression for All-Cause Mortality in Elderly Patients With HFpEF

P value

HR (95% CI)

CI: confidence interval; CONUT: Controlling Nutritional Status; GNRI: Geriatric Nutritional Risk Index; HR: hazard ratio; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

Age

0.318

1.208 (0.974–1.085)

Hypertension

0.130

0.671 (0.400–1.125)

Diabetes

0.124

1.444 (0.904–2.307)

Chronic renal insufficiency

0.283

1.288 (0.812–2.042)

GNRI score

0.043

0.962 (0.927–0.999)

CONUT score

0.001

1.366 (1.181–1.579)

NT-proBNP

0.017

1.000 (1.000–1.001)