The clinical course of acute myocarditis varies widely, making accurate prognostication difficult. Nutritional assessment aids risk stratification in various cardiovascular diseases; however, its role in myocarditis remains unclear. This study examined the association between Geriatric Nutritional Risk Index (GNRI)-defined nutritional risk, and prognosis in acute myocarditis. We analyzed admission data on patients with acute myocarditis hospitalized via emergency medical services from the multicenter Tokyo CCU Network Database between January 2017 and December 2022. Nutritional risk was assessed using the GNRI (≥ 98 normal nutrition; 92 to < 98 low; 82 to < 92 moderate; ≤82 severe). The primary outcome was in-hospital death, and secondary outcomes included hospital length of stay (LOS) and cardiovascular care unit LOS. Multivariable Cox regression assessed the association between GNRI-defined nutritional risk and outcomes, adjusting for patient characteristics. Among 402 patients, the median age was 43 years [27–66], and 24.9