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Meta-analysis links low Geriatric Nutritional Risk Index to postoperative delirium riskLow Nutrition Risk Linked to Higher Delirium After Surgery

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Key Takeaway
Consider preoperative GNRI assessment as a tool to identify surgical patients at higher risk for postoperative delirium, but recognize the association is not causal.

This meta-analysis evaluated the association between the Geriatric Nutritional Risk Index (GNRI) and postoperative delirium (POD) in surgical patients. The analysis included 12,332 patients and categorized GNRI levels to assess risk. The primary outcome was the incidence of POD.

Pooled results showed that a low GNRI was associated with a significantly increased risk of POD (RR = 1.62; 95% CI: 1.34–1.96). A trim-and-fill sensitivity analysis yielded a similar pooled estimate (RR = 1.54; 95% CI: 1.26–1.87), supporting the robustness of the finding. Subgroup analyses were performed by age, GNRI cutoff, and analysis type, along with meta-regression and publication bias assessment.

The authors noted that the funnel plot showed mild asymmetry, suggesting possible publication bias. Importantly, the included studies were observational, so the association does not imply causation. Other limitations include potential confounding and variability in GNRI cutoff values across studies.

From a clinical perspective, these findings suggest that preoperative nutritional assessment using GNRI may help identify surgical patients at higher risk for postoperative delirium. However, given the observational nature of the evidence, clinicians should interpret the association cautiously and consider it as one factor in a comprehensive risk assessment.

Researchers looked at data from over 12,300 surgical patients across multiple studies to see if nutrition levels before surgery mattered. However, because this research combines observational studies, it shows a link rather than proving cause and effect. They found that patients with lower nutritional scores were more likely to experience confusion or delirium after their procedures.

The analysis calculated that those with lower scores had about a 62 percent higher risk of delirium compared to those with higher scores. A separate check of the data confirmed this trend remained consistent even when accounting for potential biases. The study did not report any safety issues, as it looked at existing patient records rather than testing a new treatment.

While the results are promising, the mild asymmetry in the data suggests some caution is needed when interpreting the findings. Doctors might use nutritional assessments to spot patients who need extra support during recovery. Patients should view this as helpful information for planning care, not a guarantee of outcomes. It highlights the importance of discussing nutrition with your surgical team beforehand.

What this means for you:
Poor nutrition before surgery is linked to higher delirium risk, though this does not prove cause.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BackgroundMalnutrition 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.MethodsPubMed, 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.ResultsTwelve cohort studies involving 12,332 surgical patients were included. Overall, low GNRI was associated with a significantly increased risk of POD (RR = 1.62, 95% CI: 1.34–1.96; I² = 27%). Subgroup analyses showed a stronger association in studies with mean patient age > 74 years compared to ≤ 74 years (p for subgroup difference = 0.02) and in those using GNRI cutoffs < 98 compared to ≥ 98 (p = 0.04). The association was weaker in studies using multivariate analyses compared with univariate analyses (p = 0.01). Meta-regression indicated that GNRI cutoff values significantly influenced the pooled effect (p = 0.04). The funnel plot showed mild asymmetry, whereas Egger’s test was not significant (p = 0.11), and trim-and-fill analysis produced a similar pooled estimate (RR = 1.54, 95% CI: 1.26–1.87).ConclusionsLow 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.Systematic Review RegistrationThe study protocol was registered prospectively in the PROSPERO database (registration number: CRD420261335609).
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