Association between the geriatric nutritional risk index and dysphagia in older critically ill patients: A retrospective analysis of the MIMIC-IV database

Evidence regarding the association between nutritional status and dysphagia in older ICU patients remains limited. We assessed the association between the Geriatric Nutritional Risk Index (GNRI) and the prevalence of dysphagia in this population. Patients aged ≥ 65 years were identified from the MIMIC-IV (v3.1) database and divided into GNRI quartiles: Q1 (≤89.88), Q2 (89.89-99.19), Q3 (99.20-109.38), and Q4 (≥109.39). Associations were examined using logistic regression models (univariable and multivariable). Potential nonlinearity was modeled by restricted cubic splines (RCS), and the inflection point was identified via threshold-effect analysis. Robustness was then assessed through subgroup and sensitivity analyses. In 1576 patients (mean age 77.3 ± 7.8 years; 44.5% female), a lower GNRI was associated with a higher prevalence of dysphagia. Relative to the lowest quartile (Q1, reference), the adjusted odds ratios (ORs) for dysphagia in Q2, Q3, and Q4 were 0.45 (95% CI 0.30-0.69), 0.42 (95% CI 0.27-0.66), and 0.34 (95% CI 0.21-0.55), respectively (all P < .001; P for trend < 0.001). RCS analysis showed a significant nonlinear association between GNRI and dysphagia (P for nonlinearity = 0.01), and the inflection point was located at a GNRI of 91.21 (95% CI 90.85-91.56). These associations were consistent across subgroup and sensitivity analyses, although some weighted estimates should be interpreted with caution. In this cohort of older ICU patients who underwent swallowing assessment within 24 hours of admission, a lower GNRI was associated with a higher prevalence of dysphagia defined by bedside nursing swallow-screening. The association appeared more pronounced within the lower GNRI range and attenuated at higher GNRI levels. Overall, these descriptive findings indicate that dysphagia is more prevalent among patients with a lower GNRI, underscoring the importance of closely monitoring swallowing status in this subgroup.