Geriatric Nutritional Risk Index and All‐Cause Mortality in Community‐Dwelling Stroke Survivors With a Self‐Reported History: A Population‐Based Cohort Study From <scp>NHANES</scp>

BACKGROUND: Biological vulnerability and metabolic depletion are well-established determinants of stroke prognosis. However, the value of simple geriatric nutritional risk indices for risk stratification and prognosis in elderly stroke survivors remains inadequately characterized. This study aimed to investigate the association between the Geriatric Nutritional Risk Index (GNRI) and all-cause mortality among stroke survivors. METHODS: This cohort study included 958 community-dwelling stroke survivors with a self-reported history from the National Health and Nutrition Examination Survey (NHANES, 2005-2016). Weighted Cox proportional hazards regression models, accounting for the complex survey design, were employed to assess the association between GNRI (categorized by quartiles) and all-cause mortality, with sequential adjustment for demographic characteristics, socioeconomic status, laboratory parameters, and comorbidities. Dose-response relationships were evaluated using restricted cubic splines, and survival differences were analyzed via Kaplan-Meier curves with the log-rank test. RESULTS: Over a median follow-up of 67.6 months, 419 deaths were recorded. In the fully adjusted model, the highest GNRI (lowest risk) quartile (Q4) was associated with a significantly lower risk of mortality compared to the lowest GNRI (highest risk) quartile (Q1) (HR = 0.537, 95% CI: 0.389-0.743, p < 0.001). A significant inverse trend was observed across increasing GNRI quartiles (P for trend = 0.017). Restricted cubic spline analysis revealed a significant linear inverse correlation (P for nonlinear = 0.284). Kaplan-Meier analysis demonstrated significantly superior survival in survivors with GNRI ≥ 98 compared to those with GNRI < 98 (log-rank p < 0.0001). CONCLUSION: GNRI is independently associated with all-cause mortality in stroke survivors with a self-reported history. The linear inverse association suggests that characterizing biological vulnerability and homeostatic failure via GNRI may represent a viable strategy for improving long-term outcomes in this population.