Shirley Sze1,2, Pierpaolo Pellicori1,3, Jufen Zhang1,4, Joan Weston1, Andrew L Clark1. 1. Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, UK. 2. NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK. 3. Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK. 4. School of Medicine, Anglia Ruskin University, Cambridge, UK.
Abstract
BACKGROUND: Malnutrition is common in patients with chronic heart failure (CHF) and is associated with adverse outcomes, but it is uncertain how malnutrition should best be evaluated. OBJECTIVES: This prospective cohort study aims to compare the short-term prognostic value of 9 commonly used malnutrition tools in patients with CHF. METHODS: We assessed, simultaneously, 3 simple tools [Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index], 3 multidimensional tools [Malnutrition Universal Screening Tool, Mini Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment], and 3 laboratory tests (serum cholesterol, albumin, and total lymphocyte count) in consecutive patients with CHF attending a routine follow-up. The primary end point was all-cause mortality; the secondary end point was the combination of all-cause hospitalization and all-cause mortality. RESULTS: In total, 467 patients [67% male, median age 76 y (range: 21-98 y), median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1156 ng/L] were enrolled. During a median follow-up of 554 d, 82 (18%) patients died and 201 (43%) patients either had a nonelective hospitalization or died. In models corrected for age, hemoglobin (Hb), renal function, New York Heart Association (NYHA) class, NTproBNP, BMI, and comorbidities, all malnutrition tools, except total lymphocyte count and serum cholesterol, were independently associated with worse morbidity and mortality. A base model for predicting mortality, including age, NYHA class, log [NT-proBNP], Hb, renal function, and comorbidities, had a C-statistic of 0.757. CONUT (C-statistic = 0.777), among simple tools; MNA-SF (C-statistic = 0.776), among multidimensional tools; and albumin (C-statistic = 0.773), among biochemical tests, increased model performance most compared with the base model. Patients with serum albumin <30 g/L had a 6-fold increase in mortality compared with patients with albumin ≥35 g/L. CONCLUSIONS: Malnutrition is strongly associated with adverse outcomes in patients with CHF. Measuring serum albumin provides comparable prognostic information to simple or multidimensional malnutrition tools.
BACKGROUND: Malnutrition is common in patients with chronic heart failure (CHF) and is associated with adverse outcomes, but it is uncertain how malnutrition should best be evaluated. OBJECTIVES: This prospective cohort study aims to compare the short-term prognostic value of 9 commonly used malnutrition tools in patients with CHF. METHODS: We assessed, simultaneously, 3 simple tools [Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index], 3 multidimensional tools [Malnutrition Universal Screening Tool, Mini Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment], and 3 laboratory tests (serum cholesterol, albumin, and total lymphocyte count) in consecutive patients with CHF attending a routine follow-up. The primary end point was all-cause mortality; the secondary end point was the combination of all-cause hospitalization and all-cause mortality. RESULTS: In total, 467 patients [67% male, median age 76 y (range: 21-98 y), median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1156 ng/L] were enrolled. During a median follow-up of 554 d, 82 (18%) patientsdied and 201 (43%) patients either had a nonelective hospitalization or died. In models corrected for age, hemoglobin (Hb), renal function, New York Heart Association (NYHA) class, NTproBNP, BMI, and comorbidities, all malnutrition tools, except total lymphocyte count and serum cholesterol, were independently associated with worse morbidity and mortality. A base model for predicting mortality, including age, NYHA class, log [NT-proBNP], Hb, renal function, and comorbidities, had a C-statistic of 0.757. CONUT (C-statistic = 0.777), among simple tools; MNA-SF (C-statistic = 0.776), among multidimensional tools; and albumin (C-statistic = 0.773), among biochemical tests, increased model performance most compared with the base model. Patients with serum albumin <30 g/L had a 6-fold increase in mortality compared with patients with albumin ≥35 g/L. CONCLUSIONS: Malnutrition is strongly associated with adverse outcomes in patients with CHF. Measuring serum albumin provides comparable prognostic information to simple or multidimensional malnutrition tools.
Authors: Suriya Prausmüller; Gregor Heitzinger; Noemi Pavo; Georg Spinka; Georg Goliasch; Henrike Arfsten; Cornelia Gabler; Guido Strunk; Christian Hengstenberg; Martin Hülsmann; Philipp E Bartko Journal: J Cachexia Sarcopenia Muscle Date: 2022-03-29 Impact factor: 12.063