Significance of geriatric nutritional risk index in predicting lung-transplant waiting list mortality of patients with interstitial lung disease regardless of percentage forced vital capacity

OBJECTIVE: The geriatric nutritional risk index (GNRI) is derived from serum albumin, current body weight, and ideal body weight. It is a prognostic indicator for waitlist mortality in patients awaiting lung transplantation (LT). However, its significance according to respiratory function in patients with interstitial lung disease (ILD) awaiting LT remains unclear. METHODS: We retrospectively analyzed adult patients with ILD listed for LT from donation after brain death between January 2014 and July 2024. They were divided into two groups based on a cutoff of 50% for percentage forced vital capacity (%FVC). A GNRI cutoff value of 93.84 was established based on our previous study. RESULTS: Among 253 patients, 123 (48.6%) underwent LT, 81 (32.0%) died while awaiting LT, and 49 (19.4%) remained on the waiting list. The high- and low-%FVC groups included 123 (48.6%) and 130 patients (51.4%), respectively. In the high-%FVC group, 105 (85.4%) and 18 (14.6%) patients had a high and low GNRI, respectively. In the low-%FVC group, 78 (60.0%) and 52 (40.0%) patients had a high and low GNRI, respectively. In both groups, patients with a low GNRI had significantly shorter survival compared with those having a high GNRI (both P = 0.001). In multivariate analyses, low GNRI was an independent predictor of poor prognosis in both the high- and low-%FVC groups (hazard ratio = 4.918 and 2.576, P < 0.001 and = 0.001, respectively). CONCLUSIONS: The GNRI may serve as a prognostic factor for waitlist mortality in patients with ILD awaiting LT, regardless of %FVC.