# A nomogram for predicting malnutrition risk in patients with chronic heart failure and correlation study between GHRL, MSTN, CRP, Hs-CRP

## TL;DR

This study creates a tool to predict malnutrition risk in heart failure patients and explores how certain proteins and inflammation are linked to this risk.

## Contribution

This is the first study in China to integrate GHRL and MSTN into a nomogram for malnutrition risk prediction in CHF patients.

## Key findings

- Age, right upper limb diameter, simplified anorexia scale score, and MSTN are significant risk factors for malnutrition in CHF patients.
- The nomogram showed strong predictive accuracy with an AUC of 0.917 and high clinical applicability.
- MSTN was positively correlated with CRP and Hs-CRP, while GHRL was negatively correlated with these markers.

## Abstract

This study aimed to construct a nomogram to identify risk factors for malnutrition in patients with chronic heart failure (CHF) and to explore the correlation between Ghrelin (GHRL), Myostatin (MSTN), C-reactive protein (CRP) and High-sensitivity C-reactive protein (Hs-CRP) to further elucidate the potential pathophysiological mechanisms linking malnutrition/sarcopenia and inflammation.

A total of 128 patients with congestive heart failure (CHF) admitted to the Cardiology Department of Guang’anmen Hospital, China Academy of Chinese Medical Sciences, between February 2022 and February 2023, were included in the study. Based on their MNA-SF scale scores, the patients were classified into two groups: the malnutrition group (107 patients) and the non-malnutrition group (21 patients). Univariate and multivariate logistic regression analyses were performed to identify risk factors for malnutrition in CHF patients, which facilitated the development of a nomogram. Correlation analysis was also conducted to explore the relationships between GHRL, MSTN, CRP, and Hs-CRP.

Logistic regression analysis identified age, right upper limb diameter, simplified anorexia scale score, and MSTN as significant risk factors for malnutrition in CHF patients (P < 0.05). The nomogram exhibited strong discriminative power during internal validation, with an AUC of 0.917 (95% CI: 0.8439–0.990), a Hosmer–Lemeshow test result of χ2 = 7.966 (P = 0.336), a maximum Youden index of 0.701, an optimal cutoff value of 2.207, sensitivity of 77.7%, and specificity of 92.3%. Calibration curve analysis showed that the nomogram's predictions closely matched the ideal outcomes. Decision curve analysis (DCA) demonstrated that when the threshold probability exceeded 0.1, the nomogram's clinical net benefit surpassed those of the "full intervention" and "no intervention" strategies, highlighting its strong clinical applicability. Additionally, MSTN was positively correlated with CRP and Hs-CRP, while GHRL was negatively correlated with MSTN, CRP, and Hs-CRP. Significant differences were observed between MSTN, GHRL, and CRP (P < 0.05).

This study supports the hypothesis that age, right upper limb diameter, simplified anorexia scale score, and MSTN are significant risk factors for malnutrition in CHF patients. The nomogram developed in this study demonstrated robust predictive value for identifying malnutrition in this population. Furthermore, the proposed inflammation-GHRL/MSTN-appetite improvement/muscle growth-CHF improvement pathway offers a potential regulatory mechanism,which represents a promising direction for research into the mechanisms of malnutrition and muscle loss disorders in patients with CHF.

The online version contains supplementary material available at 10.1186/s12872-025-04985-1.

• This study is the first in China to integrate clinical biochemical indicators, Ghrelin (GHRL), and Myostatin (MSTN) into a nomogram for assessing malnutrition risk in CHF patients;

• It introduces innovative indicators such as GHRL and MSTN to enhance the accuracy of malnutrition risk prediction in CHF patients;

• This is the first study, to our knowledge, to investigate the correlation between GHRL, MSTN, CRP, and Hs-CRP, and to preliminarily explore the physiological and pathological mechanisms underlying malnutrition risk in CHF patients;

• Age, right upper limb diameter, simplified anorexia scale score, and MSTN were identified as significant risk factors for malnutrition in CHF patients (P<0.05). The nomogram demonstrated excellent accuracy, discrimination, and clinical applicability.

The online version contains supplementary material available at 10.1186/s12872-025-04985-1.