Prognostic impact of nutritional status assessed by the Controlling Nutritional Status score in patients with stable coronary artery disease undergoing percutaneous coronary intervention

Association between epigenetic clock acceleration and malnutrition among adults in the United States: A cross-sectional study

BACKGROUND

We investigated relationships between nutrition assessment tools (Controlling Nutritional Status [CONUT], Geriatric Nutritional Risk Index [GNRI], and Naples Prognostic Score [NPS]) and epigenetic clocks, evaluating malnutrition's impact on biological aging.

METHODS

Using National Health and Nutrition Examination Survey database (1999-2002), 2532 participants aged ≥50 years were assessed with three nutrition tools and analyzed against 12 epigenetic clocks using multiple linear regression models adjusted for confounding factors.

RESULTS

Malnutrition prevalence rates were 13.5% (CONUT), 4.2% (GNRI), and 46.8% (NPS). Compared with no-risk groups, moderate-to-severe malnutrition showed significant epigenetic age acceleration, particularly in NPS assessment. GrimAge2Mort demonstrated up to 4.19 years acceleration (in NPS model 3, P < 0.01), DunedinPoAm showed significant increase (in NPS model 3, β = 0.083, P < 0.01), and YangCell significantly decreased (in NPS model 3, β = -0.019, P < 0.01). These associations remained significant after adjusting for confounding factors. A clear dose-response relationship existed between malnutrition and epigenetic age acceleration.

CONCLUSION

This study provides first systematic evidence of significant associations between malnutrition and epigenetic age acceleration, particularly in moderate-to-severe malnutrition, leading to substantial biological aging acceleration. GrimAge2Mort, DunedinPoAm, and YangCell emerged as stable indicators for assessing nutrition-related biological aging. These findings provide new insights into malnutrition's impact on aging and offer important references for clinical nutrition intervention strategies.

Role of Nutritional Status in Acute Coronary Syndrome Patients with Diabetes

Background and Objectives: This study aims to investigate the effect of Type 2 diabetes mellitus (DM) on nutritional status in acute coronary syndrome (ACS) patients and its relationship with various metabolic and hematologic parameters. Materials and Methods: A retrospective and cross-sectional design was used to analyze 485 acute coronary syndrome (ACS) patients who underwent angiography at Fethi Sekin City Hospital between 1 January 2020 and 1 January 2025. Clinical data, biochemical parameters (hemogram, glucose, creatinine, uric acid, lactate dehydrogenase (LDH), albumin, and cholesterol levels) were retrospectively analyzed. The Prognostic Nutrition Index (PNI) and CONUT score were calculated manually. Results: A total of 485 patients were included in this study. Patients were divided into two groups: patients with DM (n = 167) and patients without DM (n = 318). Glucose levels (p < 0.001) and triglyceride levels (p = 0.014) were significantly higher in patients with diabetes, while LDL cholesterol and total cholesterol levels were lower (p < 0.01). In addition, hemoglobin (p < 0.001), albumin (p = 0.010), and PNI scores (p = 0.014) were lower in patients with diabetes. Although CONUT scores were higher in patients with diabetes, this difference was not statistically significant (p = 0.267). Significant differences were observed in lipid profile and inflammation parameters in STEMI and NSTEMI subgroups, especially in patients with diabetes. In particular, triglyceride and neutrophil levels were found to be higher in NSTEMI patients among patients with diabetes. Conclusions: The PNI score may be a useful prognostic tool for predicting cardiovascular complications and determining treatment strategies in acute coronary syndrome patients with diabetes mellitus in whom nutritional status, inflammation, and lipid metabolism are significantly correlated.

Predictive values of four nutritional indices for adverse outcomes in patients with hypertension

BACKGROUND

Malnutrition, evaluated by nutritional indices, is reportedly related to a poor prognosis in patients with hypertension. However, clinical evidence on which index is more suitable for predicting a kidney prognosis is limited, and it has not been evaluated in hypertension. The aim of the present study was to investigate and compare the predictive values of four nutritional indices: Geriatric Nutritional Risk Index (GNRI); Prognostic Nutrition Index (PNI); Triglycerides × Total cholesterol × Body weight Index (TCBI); and the controlling nutritional status (CONUT) score.

METHODS

A retrospective, cohort study of 1255 hypertensive patients under care in the Fukushima Cohort Study was conducted. The primary outcome was kidney events, defined as a combination of a 50% decline in eGFR from baseline and renal failure requiring dialysis therapy or kidney transplantation. Kaplan-Meier analyses and multivariate Cox regression analyses were conducted to examine associations between the four nutritional indices and kidney events. The area under the curve (AUC) values of the receiver-operating characteristic curves were also examined to compare the predictive values of these nutritional indices.

RESULTS

Lower GNRI, lower PNI, and higher CONUT score were significantly related to a higher risk of kidney events. GNRI (AUC = 0.729, 95% confidence interval 0.681-0.777) and PNI (AUC = 0.710, 95% confidence interval 0.665-0.756) had significantly higher AUCs for kidney events than the TCBI and CONUT score.

CONCLUSIONS

GNRI and PNI showed greater predictive values for kidney events than other nutritional indices in patients with hypertension.

Association Between the Malnutrition Status and All-Cause Mortality in Patients With Moderate and Severe Aortic Stenosis: A Prospective Cohort Study

BACKGROUND

Malnutrition status is an important predictor of prognosis in patients after aortic valve replacement. However, the prognostic value of malnutrition status in patients with moderate-to-severe aortic stenosis is unclear. This study aimed to evaluate the effect of malnutrition on all-cause mortality in patients with moderate-to-severe aortic stenosis using the Patient Controlled Nutritional Status (CONUT) score, nutritional risk index, and prognostic nutritional index.

METHODS AND RESULTS

A total of 536 patients with moderate-to-severe aortic stenosis were selected in the ARISTOTLE (Aortic Valve Diseases Risk Factor Assessment and Prognosis Model Construction) study conducted between January 2013 and December 2022 in 3 academic institutions. Patients were grouped according to different nutritional status assessment methods. CONUT, nutritional risk index, and prognostic nutritional index were calculated at baseline. The primary study outcome was all-cause mortality. Cox regression was used to assess the association between nutritional status and all-cause mortality. During a median 34.2-month follow-up period, a total of 120 (22.4%) patients died. All-cause mortality was significantly higher in lower prognostic nutritional index, lower nutritional risk index, and higher CONUT groups. Compared with normal nutrition, malnutrition was associated with an increased risk for all-cause death (adjusted hazard ratio for mild and moderate-severe malnutrition, respectively: 2.82 [95% CI, 1.69-4.71; P<0.001] and 3.31 [95% CI, 1.74-6.32; P<0.001] for the CONUT).

CONCLUSIONS

In patients with moderate or severe aortic stenosis, we found that high CONUT scores, low nutritional risk index scores, and low prognostic nutritional index scores were associated with all-cause death. The poorer the nutritional status, the greater the risk of malnutrition-related all-cause mortality.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT06069232.

Impact of Nutritional Status and Cardiopulmonary Exercise Testing-Based Exercise Education on Long-Term Outcomes in Acute Coronary Syndrome - Insights From the Mie ACS Registry

Background

Exercise training based on cardiopulmonary exercise testing (CPET) improves outcomes in patients with acute coronary syndrome (ACS), while nutritional status is also crucial. This study evaluated CPET implementation and the impacts of clinical parameters, including CPET and nutritional status, on 2-year outcomes in ACS patients.

Methods and Results

Data from 2,621 ACS patients enrolled in the Mie ACS registry were analyzed. Of these, 938 were hospitalized in CPET-equipped facilities, while 1,683 were not. Nutritional status was assessed using controlling nutritional status (CONUT) score. Cox regression analysis evaluated the associations between nutritional status, CPET-based exercise education, and 2-year prognosis. Among the 938 patients in CPET facilities, 359 underwent CPET and received exercise education. During the 2-year follow up, 60 all-cause deaths occurred. Univariate Cox regression revealed that CPET implementation was associated with lower all-cause mortality. Other predictors included hemoglobin levels, age, hospitalization length, Killip class ≥2, mechanical support, and malnutrition. In multivariate Cox regression, CPET implementation remained an independent predictor of mortality (hazard ratio 0.47; P=0.04). However, when nutritional status was included, moderate to severe malnutrition emerged as an independent predictor of all-cause mortality (hazard ratio 2.47; P=0.02), diminishing the significance of CPET (P=0.058).

Conclusions

Moderate to severe malnutrition is a powerful independent prognostic factor for mortality in the Mie ACS registry. CPET implementation may enhance survival in ACS patients.

The predictive ability of Controlling Nutritional Status score on in-hospital mortality in patients admitted to coronary care unit

OBJECTIVE

Controlling Nutritional Status score was previously described and has been used in predicting short- and long-term outcomes in different patient populations. The aim of this study was to test the relationship between Controlling Nutritional Status score and in-hospital mortality in coronary care unit patients (MORCOR-TURK population).

METHODS

In this multicenter and national study, all patients with an available Controlling Nutritional Status score were included in the analysis. The Controlling Nutritional Status score was calculated according to previously described criteria. To be able to understand the significance of the Controlling Nutritional Status score, we constructed two models. Model 1 included age, heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease history. Model 2 included the Controlling Nutritional Status score and Model 1. We then statistically compared the performances of the two models.

RESULTS

A total of 1,018 patients with known Controlling Nutritional Status scores were included in the analysis. Demographic characteristics are shown. In Model 1, the -2 log-likelihood ratio was 395.995, Nagelkerke R2 was 0.133, and area under the curve was 0.739 (95%CI 0.67-0.81). In the second model to which the Controlling Nutritional Status score is added (Model 2), the -2 log-likelihood ratio was 373.743, Nagelkerke R2 was 0.191, and area under the curve was 0.787 (95%CI 0.72-0.85). The area under the curve value of Model 2 was statistically higher than Model 1 (DeLong p-value: 0.01). A statistically significant correlation was found between death and Controlling Nutritional Status score in Model 2 [OR 1.347 (1.193-1.521), p<0.001].

CONCLUSIONS

Our study showed that the Controlling Nutritional Status score may be a significant predictor of in-hospital mortality in coronary care unit patients.

Predictive value of the controlling nutritional status (CONUT) score to assess long-term mortality (10 Years) in patients with hypertension

BACKGROUND AND AIMS

Malnutrition is associated with poor outcomes in patients with chronic diseases. The aim of this study is to investigate the prevalence of malnutrition in patients with hypertension and relationship between malnutrition severity and long-term mortality in these patients.

METHODS AND RESULTS

The study included 11,278 patients with hypertension from the National Health and Nutrition Examination Survey database. The degree of malnutrition was assessed using the Controlled Nutritional Status score, with patients divided into normal, mild, and moderate-to-severe groups. After 10 years of follow-up, the results showed that patients who died had higher CONUT scores, poorer nutritional status, and lower albumin, total cholesterol, and lymphocytes than those who survived (P < 0.05). The Kaplan-Meier analysis revealed that patients with poor nutritional status had a significantly higher risk of all-cause death. In the Non-Lipid Lowering Drugs group, the CONUT score (hazard ratio (HR): 1.225; 95% confidence interval (CI): 1.162-1.292; P < 0.0001), as well as mild (HR: 1.532; 95% CI 1.340-1.751; P < 0.0001) and moderate-to-severe malnutrition (HR: 2.797; 95% CI: 1.441-5.428; P = 0.0024), were independent predictors of long-term mortality. The competing risk regression models showed that cardiovascular and cerebrovascular mortality increased with increasing CONUT scores. The results were robust in both subgroup and sensitivity analyses.

CONCLUSIONS

Malnutrition significantly impacts long-term mortality in hypertensive patients. The CONUT score may be a useful tool for assessing the nutritional status of patients with hypertension in the non-lipid-lowering population and for predicting their long-term mortality.

Prognostic impact of malnutrition in patients with coronary artery disease: a systematic review and meta-analysis

CONTEXT

Conflicting predictions of malnutrition for the long-term prognosis of coronary artery disease (CAD) exist.

OBJECTIVE

This study aimed to investigate the relationship between malnutrition and long-term prognosis of patients with CAD.

DATA SOURCES

Four databases were searched for articles from February 11, 1936, to September 10, 2022.

DATA EXTRACTION

Cohort studies adjusting for multiple cardiovascular risk factors with data on CAD and malnutrition were included. Malnutrition was measured and defined by different nutritional evaluation tools. The hazard ratios (HRs) and confidence intervals (CIs) for all-cause mortality and major adverse cardiovascular events (MACEs) were synthesized. Subgroup analyses were performed based on study design, assessment tools, ethnicity/race, follow-up, sample size, and types of CAD. Meta-regression was used to compare whether the effect sizes of the 2 subgroups were statistically significant.

DATA ANALYSIS

A total of 30 cohort studies were included, totaling 81 361 participants with CAD. Nutritional evaluation tools, including the Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), Nutritional Risk Screening 2002, Mini-Nutritional Assessment, and Prognostic Nutritional Index, were used. Malnutrition increased all-cause mortality (HR = 1.72; 95% CI: 1.53, 1.93) and MACEs (HR = 1.47; 95% CI: 1.35, 1.60) in patients with CAD. Subgroup analysis revealed the results were consistent across study design, ethnicity/race, follow-up, sample size, and types of CAD. Subgroup analyses and meta-regression revealed that malnutrition was associated with a higher risk of all-cause mortality (HR = 2.26; 95% CI: 1.91, 2.68) and MACEs (HR = 2.28; 95% CI: 1.69, 3.08) in patients with stable CAD than those with other types of CAD. Meta-regression revealed that the GNRI (HR = 2.20; 95% CI: 1.65, 2.93) was more effective than CONUT (HR = 1.47; 95% CI: 1.21, 1.78) in predicting all-cause mortality.

CONCLUSION

Malnutrition independently increased all-cause mortality by 72% and MACEs by 47% in patients with CAD, especially with stable CAD. The GNRI is a more effective nutritional evaluation tool than CONUT in predicting all-cause mortality.

Malnutrition-Related Liver Steatosis, CONUT Score and Poor Clinical Outcomes in an Internal Medicine Department

Fatty liver disease has been identified as a marker of malnutrition in different clinical settings. Recently, the COntrolling NUTritional status score (CONUT score) emerged as a promising tool for malnutrition assessment. Our aim was to evaluate short-term outcomes among patients with malnutrition-related liver steatosis in an Internal Medicine department. Furthermore, we evaluated the association of the CONUT score with malnutrition-related liver steatosis. Data from 247 patients hospitalized in an Internal Medicine department were retrospectively collected. The study population was stratified into three groups based on hepatic radiodensity assessed with computed tomography: mild steatosis (≥56.1 HU), moderate steatosis (between 49.7 and 56 HU), and severe steatosis (≤49.6 HU). We then calculated the CONUT score. Severe steatosis patients had higher in-hospital mortality (18.2 vs. 15.5%) and longer in-hospital stays compared with the mild steatosis group (length of in-hospital stay longer than 12 days: 45% vs. 40%). Logistic regression analysis showed that severe steatosis was not significantly associated with in-hospital all-cause death, while a high CONUT score was an independent risk factor for sepsis. We found an independent relationship between malnutrition-associated liver steatosis and the CONUT score. These results identified the CONUT score as a tool for nutritional assessment of hospitalized patients.

Comparative analysis of four nutritional scores predicting the incidence of MACE in older adults with acute coronary syndromes after PCI

To determine the most appropriate nutritional assessment tool for predicting the occurrence of major adverse cardiovascular events (MACE) within 1 year in elderly ACS patients undergoing PCI from four nutritional assessment tools including PNI, GNRI, CONUT, and BMI. Consecutive cases diagnosed with acute coronary syndrome (ACS) and underwent percutaneous coronary intervention (PCI) in the Department of Cardiovascular Medicine of the Air force characteristic medical center from 1 January 2020 to 1 April 2022 were retrospectively collected. The basic clinical characteristics and relevant test and examination indexes were collected uniformly, and the cases were divided into the MACE group (174 cases) and the non-MACE group (372 cases) according to whether a major adverse cardiovascular event (MACE) had occurred within 1 year. Predictive models were constructed to assess the nutritional status of patients with the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling nutritional status (CONUT) scores, and Body Mass Index (BMI), respectively, and to analyze their relationship with prognosis. The incremental value of the four nutritional assessment tools in predicting risk was compared using the Integrated Discriminant Improvement (IDI) and the net reclassification improvement (NRI). The predictive effect of each model on the occurrence of major adverse cardiovascular events (MACE) within 1 year in elderly ACS patients undergoing PCI was assessed using area under the ROC curve (AUC), calibration curves, decision analysis curves, and clinical impact curves; comparative analyses were performed. Among the four nutritional assessment tools, the area under the curve (AUC) was significantly higher for the PNI (AUC: 0.798, 95%CI 0.755-0.840 P < 0.001) and GNRI (AUC: 0.760, 95%CI 0.715-0.804 P < 0.001) than for the CONUT (AUC: 0.719,95%CI 0.673-0.765 P < 0.001) and BMI (AUC: 0.576, 95%CI 0.522-0.630 P < 0.001). The positive predictive value (PPV) of PNI: 67.67% was better than GNRI, CONUT, and BMI, and the negative predictive value (NPV): of 83.90% was better than CONUT and BMI and similar to the NPV of GNRI. The PNI, GNRI, and CONUT were compared with BMI, respectively. The PNI had the most significant improvement in the Integrated Discriminant Improvement Index (IDI) (IDI: 0.1732, P < 0.001); the PNI also had the most significant improvement in the Net Reclassification Index (NRI) (NRI: 0.8185, P < 0.001). In addition, of the four nutritional assessment tools used in this study, the PNI was more appropriate for predicting the occurrence of major adverse cardiovascular events (MACE) within 1 year in elderly ACS patients undergoing PCI.

The Prognostic Value of Johns Hopkins Hospital Nutrition Support Score in Older Patients Undergoing Cardiovascular Surgery

OBJECTIVES

Clarify the prognostic value of the Johns Hopkins Hospital Nutrition Support (JHHNS) score on clinical outcomes in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB).

DESIGN

A retrospective observational study.

SETTING

A teaching and university hospital and tertiary referral center.

PARTICIPANTS

The authors analyzed 328 older patients aged ≥65 who underwent cardiovascular surgery with CPB in 2020.

INTERVENTIONS

Malnutrition risk was identified by the JHHNS score calculated based on specific preoperative and intraoperative objective parameters. Patients were divided into low- and high-JHHNS groups. Early morbidity, including pneumonia, bacteremia, wound infection, cerebrovascular accident, gastrointestinal bleeding, acute kidney injury, delirium, requirement for extracorporeal membrane oxygenation, and readmission to the intensive care unit (ICU), were the primary outcome; whereas in-hospital mortality, length of ICU and hospital stay, duration of mechanical ventilation and short-term mortality were secondary outcomes. The independent risk factors for postoperative complications were analyzed by logistic regression analyses.

MEASUREMENTS AND MAIN RESULTS

The JHHNS score identified 21.0% of patients at risk for malnutrition. Patients in the high-JHHNS group had prolonged median length hospital stay (21 v 24 days, p = 0.002) and mechanical ventilation (13.0 v 16.0 hours, p = 0.038), and more patients in this subgroup stayed longer than 3 days in ICU (30.1% v 43.5%, p = 0.036). Besides, they experienced more postoperative complications (11.2% v 39.1%, p < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that the JHHNS score independently predicted the risk of postoperative complications. No significant intergroup difference was observed for the short-term mortality.

CONCLUSIONS

The JHHNS score was an independent predictor for postoperative complications but did not significantly affect short-term mortality in older patients undergoing cardiovascular surgery with CPB.

Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction

Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p <0.001) and were more often women (48% vs 37%, p <0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p <0.001). Patients with malnutrition also had a significantly higher inpatient mortality (12.5% vs 4.6%, p <0.001), length of stay (mean of 13 vs 7 days, p <0.001), and 30-day all-cause readmission rates (19% vs 13%, p <0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs 0.6%, p <0.001). The univariate analysis showed that the severity of malnutrition also correlated with a higher inpatient mortality (odds ratio [OR] 2.34 [2.24 to 2.46] for mild malnutrition and 3.65 [3.49 to 3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization, the presence of malnutrition and the severity of malnutrition continued to be associated with a higher inpatient mortality than those without malnutrition (OR 1.20 [1.14 to 1.26] for mild malnutrition and OR 1.69 [1.61 to 1.78] for more severe malnutrition). In conclusion, underlying malnutrition is associated with worse outcomes in patients hospitalized with AMI. The severity of malnutrition also correlates with worse outcomes.

Prevalence and prognostic value of malnutrition in patients with acute coronary syndrome and chronic kidney disease

Background

Malnutrition is a rising global health issue associated with unfavorable outcomes of a variety of disorders. Currently, the prevalence and prognostic significance of malnutrition to patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) remained largely unclear.

Methods

A total of 705 patients diagnosed with ACS and CKD in the First Affiliated Hospital of Wenzhou Medical University between 2013 and 2021 were included in this retrospective cohort study. Malnutrition was assessed by the Controlling Nutritional Status (CONUT), the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI), respectively. The relationships between malnutrition and all-cause mortality and major cardiovascular events (MACEs) were analyzed.

Results

During a median follow-up of 31 months, 153 (21.7%) patients died, and 165 (23.4%) had MACEs. The prevalence of malnutrition was 29.8, 80.6, and 89.8% for the PNI, CONUT, and GNRI, respectively. All the malnutrition indexes were correlated with each other (r = 0.77 between GNRI and PNI, r = -0.72 between GNRI and CONUT, and r = -0.88 between PNI and CONUT, all p < 0.001). Compared with normal nutrition, malnutrition was independently associated with an increased risk for all-cause mortality (adjusted hazard ratio for moderate and severe degrees of malnutrition, respectively: 7.23 [95% confidence interval (CI): 2.69 to 19.49] and 17.56 [95% CI: 5.61 to 55.09] for the CONUT score, 2.18 [95% CI: 0.93 to 5.13] and 3.16 [95% CI: 1.28 to 7.79] for the GNRI, and 2.52 [95% CI: 1.62 to 3.94] and 3.46 [95% CI: 2.28 to 5.25] for the PNI score. p values were lower than 0.05 for all nutritional indexes, except for moderate GNRI p value = 0.075). As for MACEs, similar results were observed in the CONUT and PNI. All the risk scores could improve the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score for both all-cause mortality and MACEs.

Conclusion

Malnutrition was common in patients with ACS and CKD regardless of the screening tools used, and was independently associated with all-cause mortality and MACEs. Malnutrition scores could facilitate risk stratification and prognosis assessment.

Controlling Nutritional Status (CONUT) Score as a Potential Prognostic Indicator of In-Hospital Mortality, Sepsis and Length of Stay in an Internal Medicine Department

The controlling nutritional status (CONUT) score represents poor nutritional status and has been identified as an indicator of adverse outcomes. Our aim was to evaluate the prognostic role of the CONUT score on in-hospital outcomes in an Internal Medicine Department. This is a retrospective study analyzing data from 369 patients, divided into four groups based on the CONUT score: normal (0-1), mild-high (2-4), moderate-high (5-8), and marked high (9-12). In-hospital all-cause mortality increased from normal to marked high CONUT score group (2.2% vs. 3.6% vs. 13.4% vs. 15.3%, p < 0.009). Furthermore, a higher CONUT score was linked to a longer length of hospital stay (LOS) (9.48 ± 6.22 vs. 11.09 ± 7.11 vs. 12.45 ± 7.88 vs. 13.10 ± 8.12, p < 0.013) and an increased prevalence of sepsis. The excess risk of a high CONUT score relative to a low CONUT score remained significant after adjusting for confounders (all-cause mortality: OR: 3.3, 95% CI: 1.1-9.7, p < 0.02; sepsis: OR: 2.7, 95% CI: 1.5-4.9, p < 0.01; LOS: OR: 2.1, 95% CI: 1.2-3.9, p < 0.007). The present study demonstrated that an increased CONUT score is related to a higher risk of short-term in-hospital death and complications.

Association of Controlling Nutritional Status Score With Adverse Outcomes in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to examine the association between the controlling nutritional status (CONUT) score and adverse outcomes in patients with coronary artery disease (CAD). PubMed and Embase databases were searched for eligible studies from their inceptions to December 12, 2021 to identify studies investigating the association of the CONUT score with major adverse cardiovascular events (MACEs) and all-cause mortality in CAD patients. Twelve studies (36,198 CAD) patients satisfied the criteria. Comparison of the high with low CONUT score, the pooled multivariate adjusted risk ratios (RR) was 1.78 (95% confidence intervals [CI] 1.36-2.32) for MACEs and 1.45 (95% CI 1.27-1.66) for all-cause mortality, respectively. When compared with patients with normal nutrition, malnourished (defined by the CONUT score ≥2) patients conferred a 52% increased risk of MACEs. Additionally, per point CONUT score increment was associated with 15% and 11% higher risk of MACEs and all-cause mortality, respectively. Higher CONUT score independently predicts the MACEs all-cause mortality in CAD patients. Estimation of nutritional status using the CONUT score could be helpful for improving risk classification of CAD.

Prognostic Value of Four Preimplantation Malnutrition Estimation Tools in Predicting Heart Failure Hospitalization of the Older Diabetic Patients with Right Ventricular Pacing

OBJECTIVES

The prognostic value of preimplantation nutritional status is not yet known for older diabetic patients that received right ventricular pacing (RVP). The study aimed to investigate the clinical value of the four malnutrition screening tools for the prediction of heart failure hospitalization (HFH) in older diabetic patients that received RVP.

DESIGN

Retrospective observational cohort study.

SETTING AND PARTICIPANTS

This study was conducted between January 2017 and January 2018 at the Fuwai Hospital, Beijing, China, and included older (age ≥ 65 years) diabetic patients that received RVP for the first time Measurements: The Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Naples Prognostic Score (NPS), and the Controlling Nutritional Status (CONUT) score were used to estimate the preimplantation nutritional status of the patients. Univariate and multivariate Cox proportional hazard regression analyses were performed to investigate the association between preimplantation malnutrition and HFH.

RESULTS

Overall, 231 older diabetic patients receiving RVP were included. The median follow-up period after RVP was 53 months. HFH was reported for 19.9% of the included patients. Our results showed preimplantation malnutrition for 18.2%, 15.2%, 86.6% and 66.2% of the included patients based on the PNI, GNRI, NPS, and CONUT score, respectively. The cumulative rate of HFH during follow-up period was significantly higher for patients in the preimplantation malnutrition group based on the PNI (log-rank = 13.0, P = 0.001), GNRI (log-rank = 8.5, P = 0.01), and NPS (log-rank = 15.7, P < 0.001) compared to the normal nutrition group, but was not statistically significant for those in the preimplantation malnutrition group based on the CONUT score (log-rank = 2.7, P = 0.3). As continuous variables, all the nutritional indices showed significant correlation with HFH (all P < 0.05). However, multivariate analysis showed that only GNRI was independently associated with HFH (HR = 0.97, 95% CI: 0.937-0.997, P = 0.032). As categorical variables, PNI, GNRI, and NPS showed significant correlation with HFH. After adjustment of confounding factors, moderate-to-severe degree of malnutrition was an independent predictor of HFH based on the PNI (HR = 4.66, 95% CI: 1.03-21.00, P = 0.045) and GNRI (HR = 3.02, 95% CI: 1.02-9.00, P = 0.047).

CONCLUSION

Preimplantation malnutrition was highly prevalent in older diabetic patients that received RVP. The malnutrition prediction tools, PNI and GNRI, showed significant prognostic value in accurately predicting HFH in older diabetic patients with RVP.

Clinical Outcomes Based on the Attainment of Low-Density Lipoprotein Cholesterol Targets in Patients with Acute Coronary Syndrome in Real-World Practice

Objective

A target of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL or ≥50% reduction should be set. This study aimed to explore the information required to attain the optimal goal of lipid control for patients with ACS in real-world practice using big database analysis.

Methods

Patients with ACS were enrolled between January 2005 and December 2019, and their medical history was obtained from the Chang Gung Research database. According to the attainment of LDL-C levels, the study population was divided into groups with and without ≥50% reduced LDL-C levels. In the group that achieved ≥50% reduced LDL-C levels, the study population was subdivided into groups with and without achievement of LDL-C level < 70 mg/dL.

Results

This study enrolled 14,520 participants, out of whom only 3,367 patients (23.2%) achieved ≥50% reduced LDL-C levels. At the 3-year follow-up periods, higher incidences of cardiovascular (CV) mortality and all-cause mortality were absorbed in patients without ≥50% reduced LDL-C levels, especially in subgroups of hypertension and diabetes mellitus (DM). When comparing different percentages of reduced LDL-C levels, the significantly lowest hazard ratio (HR) of CV and all-cause mortality was noted at ≥50% reduced LDL-C levels (CV mortality; HR: 0.64; all-cause mortality; HR: 0.57).

Conclusion

In the ACS population, better clinical outcomes were yielded in patients with ≥50% reduced LDL-C levels, especially in the hypertension and DM populations. However, strict lipid control did not show better clinical outcomes in patients with ≥50% reduction and <70 mg/dL in LDL-C levels.

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

The prevalence and role of malnutrition in periprosthetic joint infection (PJI) remain unclear. This study aimed to use measurable nutritional screening tools to assess the prevalence of malnutrition in PJI patients during two-stage exchange arthroplasty and to explore the association between malnutrition and treatment failure. Our study retrospectively included 183 PJI cases who underwent 1st stage exchange arthroplasty and had available nutritional parameters, of which 167 proceeded with 2nd stage reimplantation. The recently proposed Musculoskeletal Infection Society (MSIS) Outcome Reporting Tool was used to determine clinical outcomes. The Controlling Nutritional Status (CONUT), Nutritional Risk Index (NRI), and Naples Prognostic Score (NPS) were used to identify malnutrition at 1st and 2nd stage exchange, respectively. Multivariate logistic regression analyses were performed to determine the association between malnutrition and treatment failure. Restricted cubic spline models were further used to explore the dose−response association. Additionally, risk factors for moderate-to-severe malnutrition were evaluated. Malnourished patients identified by CONUT, NPS, and NRI accounted for 48.1% (88/183), 98.9% (181/183), and 55.7% (102/183) of patients at 1st stage, and 9.0% (15/167), 41.9% (70/167), and 43.1% (72/167) at 2nd stage, indicating a significant improvement in nutritional status. We found that poorer nutritional status was a predictor of treatment failure, with CONUT performing best as a predictive tool. Moderate-to-severe malnutrition at 1st stage identified by CONUT was significantly related to treatment failure directly caused by PJI (odds ratio [OR] = 5.86), while the OR was raised to 12.15 at 2nd stage (OR = 12.15). The linear dose−response associations between them were also confirmed (P for nonlinearity at both 1st and 2nd stage > 0.05). As for total treatment failure, moderate-to-severe malnutrition as determined by CONUT was associated with a 1.96-fold and 8.99-fold elevated risk at the 1st and 2nd stages, respectively. Age ≥ 68 years (OR = 5.35) and an increased number of previous surgeries (OR = 2.04) may be risk factors for moderate-to-severe malnutrition. Overall, the prevalence of malnutrition in PJI patients is very high. Given the strong association between moderate-to-severe malnutrition identified by CONUT and PJI treatment failure, COUNT could be a promising tool to evaluate the nutritional status of PJI patients to optimize treatment outcomes.

Prognostic value of a novel dNLR-PNI score in patients with acute coronary syndrome undergoing percutaneous coronary intervention

There is currently limited information on the prognostic value of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) score for patients with acute coronary syndrome (ACS). We aimed to explore the predictive value of a dNLR-PNI score on the long-term prognosis of patients with ACS undergoing percutaneous coronary intervention (PCI). A total of 1773 patients with ACS who underwent PCI were consecutively enrolled from January 2016 to December 2018. The cutoff values of dNLR and PNI to predict major adverse cardiovascular events (MACE) were calculated using receiver operating characteristic curves. The patients were divided into three groups based on the dNLR-PNI score, and Kaplan-Meier curves and Cox regression models were used for survival analysis. The endpoints were MACE, including all-cause mortality and rehospitalisation for severe heart failure during follow-up. A total of 1542 patients with ACS who underwent PCI were included. Kaplan-Meier curves showed that a higher level of dNLR, PNI, or dNLR-PNI score was associated with a higher risk of MACE (allp < .001). In multivariate Cox regression models, the dNLR-PNI two score (hazard ratio 3.049, 95% confidence interval 1.503-6.184, p = .002) was found to be an independent predictor of all-cause mortality and rehospitalization for severe heart failure. A high dNLR-PNI score was independently associated with a higher risk of developing MACE in patients with ACS undergoing PCI. The dNLR-PNI score may be a useful prognostic parameter for identifying high-risk ACS patients after PCI.

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis

Background

As defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD).

Methods

Observational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase.

Results

Of 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I² = 0%), (1.53 [95% CI: 1.26–1.84], I² = 84%), and (2.24 [95% CI: 1.57–3.19], I² = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I² = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I² = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively.

Conclusion

As defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

Nutritional indices at admission are associated with mortality rates of patients in the intensive care unit

BACKGROUND

Malnutrition is a common occurrence in critically ill patients, and has been related to poor prognosis in various diseases. Here, we assess the prognostic value of malnutrition using nutritional indices in intensive care units (ICU) patients.

METHODS

We retrieved information on 2060 patients from the Medical Information Mart for Intensive Care III, and randomized the patients into training and validation cohorts, at a ratio of 7:3. We estimated their nutritional indices using prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) score. Both multivariate regression analysis and the Kaplan-Meier (KM) survival curve were used to examine the prognostic role of nutritional indices in ICU mortality. Then we evaluated the additional predictive significance of each nutritional index beyond the baseline model including conventional risk factors.

RESULTS

Multivariate regression analysis revealed that PNI, GNRI, and CONUT were independent predictors of in-hospital and 1-year mortality (all P < 0.001). KM curves showed higher 1-year mortality rates in having nutritional risk patients (PNI ≤ 38 or GNRI ≤ 98 or CONUT ≥ 2). Moreover, subgroup analyses revealed a significant association between each nutritional index and 1-year mortality in patients with different comorbidities. We also observed a pronounced additional impact on the predictive value of 1-year mortality when PNI, GNRI, and CONUT were separately added to the baseline model. The additional role of each nutritional index was further verified in the validation cohort.

CONCLUSIONS

Our results revealed that the nutritional indices at admission are significantly correlated with increased mortality rates in ICU adult patients.

Prevalence and Prognostic Significance of Malnutrition in Hypertensive Patients in a Community Setting

BACKGROUND

Malnutrition is a significantly poor prognostic factor for a variety of cardiovascular diseases. However, its prevalence and prognostic value in hypertensive patients is still unclear. The present study sought to determine the prevalence and prognostic value of malnutrition in hypertensive patients in a community setting.

METHODS

We included 9,949 hypertensive patients from the National Health and Nutrition Examination Survey (NHANES) (2005-2014). The Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Naples Prognostic Score (NPS) were applied to assess the nutritional status of participants. A Cox regression model was established to examine the association between malnutrition and cardiovascular and all-cause mortality.

RESULTS

In all, 19.9, 3.9, and 82.9% hypertensive patients were considered to have malnutrition as evaluated by the CONUT, NRI, and NPS, respectively. Malnutrition assessed by CONUT and NRI was independently associated with cardiovascular mortality (HR [95% CI]) for mild and moderate-to-severe degree of malnutrition, respectively: 1.41 (1.04-1.91) and 5.79 (2.34-14.29) for CONUT; 2.60 (1.34-5.07) and 3.30 (1.66-6.56) for NRI (all P < 0.05), and for all-cause mortality (HR [95% CI]) for mild and moderate-to-severe degree of malnutrition, respectively: 1.48 (1.30-1.70) and 4.87 (3.40-6.98) for CONUT; 1.72 (1.24-2.39) and 2.60 (1.96-3.44) for NRI (all P < 0.01). Naples Prognostic Score could only independently predict all-cause mortality.

CONCLUSIONS

Malnutrition was common among hypertensive patients and was closely associated with both long-term cardiovascular and all-cause mortality.

Paradoxical Association Between Baseline Apolipoprotein B and Prognosis in Coronary Artery Disease: A 36,460 Chinese Cohort Study

Background

Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) were identified targets for blood lipid management among coronary artery disease (CAD) patients. However, previous studies reported an inverse correlation between baseline LDL-C concentration and clinical outcomes. This study aims to explore the definite association between baseline ApoB and long-term prognosis.

Methods

A total of 36,460 CAD patients admitted to Guangdong Provincial People's Hospital were enrolled and categorized into two groups: high ApoB (≥65 mg/dL) group and low ApoB (<65 mg/dL) group. The association between baseline ApoB and long-term all-cause mortality was evaluated by the Kaplan-Meier method, Cox regression analyses and restricted cubic splines.

Results

The overall mortality was 12.49% (n = 4,554) over a median follow-up period of 5.01 years. Patients with low baseline ApoB levels were paradoxically more likely to get a worse prognosis. There was no obvious difference in risk of long-term all-cause mortality when only adjusted for age, gender, and comorbidity (aHR: 1.07, 95% CI: 0.99–1.16). When CONUT and total bilirubin were adjusted, the risk of long-term all-cause mortality would reduce in the low-ApoB (<65 mg/dL) group (aHR: 0.86, 95% CI: 0.78–0.96). In the fully covariable-adjusted model, patients in the ApoB <65 mg/d group had a 10.00% lower risk of long-term all-cause mortality comparing to patients with ApoB ≥65 mg/dL (aHR: 0.90; 95% CI:0.81–0.99).

Conclusion

This study found a paradoxical association between baseline ApoB and long-term all-cause mortality. Malnutrition and bilirubin mainly mediate the ApoB paradox. Increased ApoB concentration remained linearly associated with an increased risk of long-term all-cause mortality.

Nomograms Based on the Advanced Lung Cancer Inflammation Index for the Prediction of Coronary Artery Disease and Calcification

Aim

To develop and validate 3 nomograms incorporating the advanced lung cancer inflammation index (ALI) that can aid in predicting the risk of coronary artery disease (CAD) and coronary artery calcification (CAC).

Methods

The study enrolled 562 consecutive patients with suspected CAD who underwent coronary computed tomographic angiography between September 2015 and June 2017. Independent risk factors for CAD, CAC, and CAD with CAC were identified via univariate and multivariate analysis, and nomograms were established based on the independent predictors identified. The area under the curve (AUC), calibration curve, and decision curve analysis were used to evaluate the nomograms. Correlations between ALI and other clinical indicators were examined via Spearman correlation analysis.

Results

In total, 549 patients with suspected CAD who underwent coronary computed tomographic angiography were included. Male sex, hypertension, diabetes, dyslipidemia, ischemic stroke, and ALI were independent predictors of both CAD and CAC. Male sex, hypertension, diabetes, dyslipidemia, and ALI were also identified as independent predictors of CAD with CAC. The AUC values for the nomograms developed using these risk factors were 0.739 (95% confidence interval [CI], 0.693-0.785), 0.728 (95% CI, 0.684-0.772), and 0.717 (95% CI 0.673-0.761), respectively. ALI was negatively correlated with neutrophil-to-lymphocyte ratio and CAC score and positively correlated with serum albumin levels and body mass index (all P < .05).

Conclusions

ALI is an independent predictor of CAD, CAC, and CAD with CAC. Our ALI-based nomograms can provide accurate and individualized risk predictions for patients with suspected CAD.

Malnutrition and Risk of Procedural Complications in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Background: Little is known about the prognostic value of nutritional status among patients undergoing atrial fibrillation (AF) catheter ablation (AFCA). We compared the risk of procedure-related complications and long-term rhythm outcomes of AFCA according to nutritional status.

Methods: We included 3,239 patients undergoing de novo AFCA in 2009-2020. Nutritional status was assessed using the controlling nutritional status (CONUT) score. The association between malnutrition and the risk of AFCA complications or long-term rhythm outcomes was evaluated. We validated the effects of malnutrition using an external cohort of 360 patients undergoing AFCA in 2013-2016.

Results: In the study population (26.8% women, median age: 58 years), 1,005 (31.0%) had malnutrition (CONUT scores ≥ 2); 991 (30.6%) had mild (CONUT 2–4) and 14 (0.4%) had moderate-to-severe (CONUT ≥ 5) malnutrition. The overall complication rates after AFCA were 3.3% for normal nutrition, 4.2% for mild malnutrition, and 21.4% for moderate-to-severe malnutrition. Moderate-to-severe malnutrition [odds ratio (OR) 6.456, 95% confidence interval (CI) 1.637-25.463, compared with normal nutrition], older age (OR 1.020 per 1-year increase, 95% CI 1.001-1.039), female sex (OR 1.915, 95% CI 1.302-2.817), and higher systolic blood pressure (OR 1.013 per 1-mmHg increase, 95% CI 1.000-1.026) were independent predictors for the occurrence of complications. In the validation cohort, malnutrition (CONUT ≥ 2) was associated with a 2.87-fold higher risk of AFCA complications (95% CI 1.174-7.033). The association between malnutrition and a higher risk of AFCA complications was consistently observed regardless of body mass index and sex. Malnutrition did not affect rhythm outcomes during the median follow-up of 40 months (clinical recurrence: 37.0% in normal nutrition vs. 36.5% in malnutrition).

Conclusion: Malnutrition, which is common in patients undergoing AFCA, was associated with a substantially higher risk for complications after AFCA.

Mild Malnutrition Contributes the Greatest to the Poor Prognosis in Coronary Artery Disease With Well-Controlled Low-Density Lipoprotein Cholesterol Levels: A 4,863 Chinese Cohort Study

Background: Previous studies reported that patients with coronary artery disease (CAD) and well-controlled baseline LDL-C (<1.8 mmol/L) still had higher long-term all-cause mortality. However, no study has been conducted to explore the independent risk factors for long-term mortality. In addition, there also was no study evaluating the population attributable risk (PAR) of independent risk factors in combination with their prevalence and relative risk. Therefore, we aimed to identify the independent risk factors and estimate their PAR in patients with CAD and well-controlled baseline LDL-C (<1.8 mmol/L). Methods: We analyzed 4,863 consecutive CAD patients with well-controlled baseline LDL-C admitted to Guangdong Provincial People's Hospital in China from January 2007 to December 2018. Independent risk factors for long-term all-cause death were evaluated through stepwise approach and multivariable Cox regression analysis. PAR of independent risk factors was calculated with their hazard ratio and prevalence among our cohort. Results: The overall mortality was 16.00% (n = 778) over a median follow-up period of 5.93 years. Independent risk factors for all-cause death included malnutrition, age ≥75 years, congestive heart failure (CHF), chronic kidney disease (CKD) and atrial fibrillation. Among these risk factors of interest, the hazard ratio (HR) of severe malnutrition was the highest (HR 2.82, 95% CI: 1.86-4.26), and the PAR of mild malnutrition was the highest (19.49%, 95% CI: 0.65-36.01%). Conclusion: Malnutrition, age ≥75 years, CHF, CKD and atrial fibrillation were independent predictors for long-term all-cause mortality in CAD patients with well-controlled LDL-C levels. Considering prevalence of these risk factors, more attention should be paid to the occurrence of mild malnutrition for these patients. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04407936.

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy: Efficacy of the pretreatment Geriatric Nutritional Risk Index for predicting severe adverse events

OBJECTIVE

The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool. Although concurrent chemoradiotherapy (CCRT), particularly cisplatin-based CCRT, is a standard treatment for locoregional advanced head and neck squamous cell carcinoma (HNSCC), the predictive factors of adverse events related to CCRT remain to be elucidated. The present study aimed to determine the association between GNRI and CCRT-related adverse events in patients of all ages with head and neck cancer (HNC) who underwent CCRT.

METHODS

We retrospectively analyzed and compared the clinical characteristics and adverse events of 82 patients with HNC treated with CCRT according to their GNRI at the Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba Hospital, between May 2014 and November 2019. The GNRI was calculated according to the equation: 1.489 × serum albumin (g/L) + 41.7 × (body weight/ideal body weight). We compared two groups: low GNRI (GNRI < 98) and normal GNRI (GNRI ≥ 98) groups.

RESULTS

Eighty-two patients were enrolled in this study. There were 61 (76%) and 21 (26%) patients in the normal GNRI group and low GNRI group, respectively. There were significant differences in the incidence of grade ≥ 3 radiation mucositis, radiation dermatitis, and leukopenia between the low GNRI group and the normal GNRI groups.

CONCLUSIONS

Patients with low GNRI scores were more likely to have severe adverse events. Pretreatment GNRI predicted severe CCRT-related adverse events in patients of all ages with HNC undergoing CCRT.

Combined effects of nutritional status on long-term mortality in patients with non-st segment elevation myocardial infarction undergoing percutaneous coronary intervention

OBJECTIVE

The aim of this study was to investigate the performance of controlling nutritional status (CONUT) index, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) scores in predicting the long-term prognosis of patients with non-ST-elevated myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI).

METHODS

A total of 915 patients with NSTEMI (female: 48.4%; mean age: 73.1±9.0 years) who underwent PCI at Adana Numune Training and Research Hospital, Cardiology Clinic between January 2014 and January 2015 were included in this cross-sectional and retrospective study. CONUT, GNRI, and PNI scores were calculated based on the admission data derived from samples of peripheral venous blood. The mean follow-up duration was 64.5±15.4 months.

RESULTS

During follow-up (mean 64.5±15.4 months), 179 patients (19.6%) died. The mean GNRI and PNI scores were significantly lower in the nonsurvivor group; however, the median CONUT score was significantly higher in the nonsurvivor group compared with the survivor group. The receiver operating characteristic (ROC) curve analyses have shown that GNRI score has similar performance to the CONUT score and has better performance than PNI score in predicting 5-year mortality. The Kaplan-Meier curve analysis has shown that patients with lower PNI or GNRI had higher cumulative mortality than the patients with higher PNI or GNRI. Also, the patients with higher CONUT scores had higher cumulative mortality compared with those with lower scores. The multivariate analyses have shown that GNRI (HR: 0.973), PNI (HR: 0.967), CONUT score (HR: 1.527), and body mass index (BMI) (HR: 0.818) were independent predictors of the 5-year mortality in patients with NSTEMI.

CONCLUSION

In this study, we have shown that CONUT score, GNRI, and PNI values were associated with the long-term mortality in patients with NSTEMI who underwent PCI, and GNRI yielded similar results to CONUT score but was better than PNI.

Impact of the Malnutrition on Mortality in Elderly Patients Undergoing Percutaneous Coronary Intervention

Purpose

Malnutrition has been shown to be related to adverse clinical outcomes in patients with heart failure, hypertension, atrial fibrillation and other cardiovascular diseases. However, in the patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCI), especially in the elderly, the association of nutritional state and all-cause mortality remains unknown. We aimed to investigate the association of malnutrition with all-cause mortality in the elder patients undergoing PCI.

Patients and Methods

Based on the largest retrospective and observational cohort study from January 2007 to December 2017, the Controlling Nutritional Status (CONUT) score was applied to 21,479 consecutive patients with age ≥60 who undergoing PCI for nutritional assessment. Participants were classified as absent, mild, moderate and severe malnutrition by CONUT score. The Kaplan-Meier method was used to compare all-cause mortality among the above four groups. Multivariable Cox proportional hazard regression analyses were performed to examine the association of malnutrition with all-cause mortality.

Results

According to the CONUT score, 48.19%, 15.08% and 0.94% patients were mildly, moderately and severely malnourished, respectively. During a median follow-up of 5.16 years (interquartile range: 3.02 to 7.89 years), 3173 (14.77%) patients died. Kaplan-Meier analysis showed that the risk of all-cause mortality was significantly higher in patients with a worse nutritional status. Compared with normal nutritional state, malnutrition was associated with significantly increased risk for all-cause mortality (adjusted hazard ratio for mild, moderate and severe degrees of malnutrition, respectively: 1.20 [95% confidence interval (CI): 1.09 to 1.33], 1.32 [95% CI: 1.17 to 1.49] and 1.76 [95% CI: 1.33 to 2.33]).

Conclusion

Malnutrition is prevalent among elderly patients with CAD undergoing PCI, and is strongly related to the all-cause mortality increasing. For elderly patients with CAD undergoing PCI, it is necessary to assess the status of nutrition, and evaluate the efficacy of nutritional interventions.

Malnutrition and the risk for contrast-induced acute kidney injury in patients with coronary artery disease

PURPOSE

Malnutrition is a common comorbidity of coronary artery disease (CAD) and is often associated with adverse events. The malnutrition often means lower cholesterol, albumin and high lymphocyte, as risk factors of Contrast-Induced Acute Kidney Injury (CI-AKI). We aim to evaluate the association between malnutrition and CI-AKI following coronary angiography (CAG) in CAD patients.

METHODS

We analyzed 3170 CAD patients with variables of nutritional status (Controlling Nutritional Status score (CONUT)) from the prospective multicenter study, REICIN (NCT01402232) including 4,271 consecutive patients undergoing CAG from January 2013 to February 2016. Patients were divided into the normal group (CONUT score 0-1) and malnutrition group (CONUT score > 1). The association of malnutrition and the risk of CI-AKI was examined in all CAD patients using multivariable logistics regression analysis.

RESULTS

Among the 3170 patients (mean age: 63.1 ± 10.7 years), 1865 (58.8%) suffered from malnutrition, 111 (3.5%) developed CI-AKI, including 23 (1.76%) in normal group and 88 (4.72%) in malnutrition group (p < 0.01). The malnourished patients were older, and likely had anemia and worse cardiorenal function. After adjustment for confounders, the risk of CI-AKI was 1.04 times higher in the malnutrition group than in the normal group (adjusted OR: 2.04, 95% CI 1.28-3.38, p < 0.01).

CONCLUSIONS

Among CAD patients undergoing CAG, malnutrition is extremely common and associated with a double risk of CI-AKI. Further studies are needed to investigate the potential renal protection of intervening malnutrition in CAD patients.

Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study

BACKGROUND

Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the "cholesterol paradox". Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.

METHOD

A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition.

RESULT

In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05-7.78 years]. Kaplan-Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).

CONCLUSION

This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition.

Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases

Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed.

Comparative analysis of three nutrition scores in predicting mortality after acute myocardial infarction

OBJECTIVE

We investigated the utility of nutrition scores in predicting mortality and prognostic importance of nutrition status using three different scoring systems in patients with acute myocardial infarction (AMI).

METHODS

In total, 1147 patients with AMI were enrolled in this study (72.5 % men; mean age 65.6 years). Patients were divided into three groups according to the geriatric nutritional risk index (GNRI); prognostic nutritional index (PNI); and triglycerides, total cholesterol, and body weight index(TCBI) scores as tertile: low (GNRI ≤ 103.8, n = 382), intermediate (103.8 < GNRI ≤ 112.3, n = 383), and high (GNRI > 112.3, n = 382) GNRI groups; low (PNI ≤ 50.0, n = 382), intermediate (50.0 < PNI ≤ 56.1, n = 383), and high (PNI > 56.1, n = 382) PNI groups; and low (TCBI ≤ 1086.4, n = 382), intermediate (1086.3 < GNRI ≤ 2139.1, n = 383), and high (TCBI > 2139.1, n = 382) TCBI groups.

RESULTS

In the GNRI, TCBI, and PNI groups, the cumulative incidence of all-cause death and major adverse cardiovascular events (MACEs) was significantly higher in the low score group, followed by the intermediate and high score groups. Moreover, both intermediate and low PNI groups had a similar cumulative incidence of all-cause death and MACE. The GNRI score (AUC 0.753, 95% CI 0.608~0.745, P = 0.009) had significantly higher areas under the curve (AUCs) than the TCBI (AUC 0.659, 95% CI 0.600~0.719, reference) and PNI (AUC 0.676, 95% CI 0.608~0.745, P = 0.669) scores.

CONCLUSIONS

Patients with low nutrition scores were at a higher risk of MACE and all-cause death than patients with high nutrition scores. Additionally, the GNRI had the greatest incremental value in predicting risks among the three different scoring systems used in this study.

The impact of malnutrition on atrial fibrillation recurrence post ablation

BACKGROUND AND AIMS

Both malnutrition and atrial fibrillation (AF) are the major health problems in modern society. Only a few studies focused on the relationship between malnutrition and recurrence of atrial arrhythmias post AF ablation (AF recurrence), which used body mass index (BMI) as nutrition assessment tool. However, BMI can't credibly reflect body composition and has limitation in patients with water-sodium retention. In this study, we used controlling nutritional status score (CONUT score) and geriatric nutritional risk index (GNRI) to identify the malnutrition patients and explored the effect of malnutrition on AF recurrence.

METHODS AND RESULTS

This retrospective study included 246 patients who underwent AF ablation. During a median 11-month follow-up, 77 patients (31.3%) experienced AF recurrence. The recurrence group had higher CONUT score (2.3 ± 1.5 vs. 0.9 ± 1.0, P < 0.001) and lower GNRI (99.9 ± 7.6 vs. 103.9 ± 5.6, P < 0.001). After balancing the traditional risk factors, both CONUT score (OR: 2.614, 95%CI: 1.831-3.731, P < 0.001) and GNRI (OR: 0.884, 95%CI: 0.828-0.944, P < 0.001) were the independent predictors for AF recurrence. Pre-ablation CONUT score ≥1 and GNRI≥95.66 are indicative of AF recurrence. Adding CONUT score or GNRI to the base prediction model for AF recurrence significantly improved the discrimination and calibration. However, adding BMI to the base prediction model did not improve the model performance.

CONCLUSIONS

CONUT score and GNRI are ideal tools to evaluate the nutrition status of AF patients. Undernourished patients are more likely to suffer from AF recurrence. Improving nutrition status may be a potential target for reducing the postoperative recurrence rate.

Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial)

AIM

Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in-hospital and long-term mortality in patients undergoing surgical aortic valve replacement (SAVR).

METHODS

PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66-74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes.

RESULTS

During the 50 ± 31 months follow-up period, a total of 36 (24%) patients died. 30-day mortality, 1-year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0-2] vs. 2 [0.2-3]; p < .001) was significantly higher.

CONCLUSION

Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.

Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty

INTRODUCTION

Many studies have examined nutritional status and deteriorated postoperative outcomes in patients undergoing total hip arthroplasty. However, few studies have focused on nutritional status and postoperative mobility.

OBJECTIVE

To investigate the impact of preoperative nutritional status on mobility after total hip arthroplasty.

DESIGN

Retrospective single-institution cohort study.

SETTING

Orthopedic inpatient rehabilitation center.

PARTICIPANTS

A total of 503 patients who underwent unilateral primary total hip arthroplasty from 2015 through 2019 were included.

METHODS

Data were collected on patient demographics, comorbidities, preoperative nutritional status, and quadriceps strength. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The primary outcome was postoperative mobility defined as the number of days from surgery to starting to walk independently.

RESULTS

Among 503 patients undergoing total hip arthroplasty, 18.9% were classified as malnourished. Patients with malnutrition had a one-day delay in achieving mobilization compared with patients with normal nutrition (6 vs. 5 days, P = .006). According to the Kaplan-Meier curves, patients with malnutrition had a significant delay in mobilization compared with those with normal nutrition (P < .001). All three Cox proportional hazards regression models showed that preoperative malnutrition was associated with a higher risk of delayed mobilization (hazard ratios 0.70-0.74).

CONCLUSIONS

Preoperative malnutrition as assessed by the CONUT is a significant risk factor for delayed recovery of mobilization after total hip arthroplasty.

Prognostic significance of the controlling nutritional (CONUT) score in patients with acute coronary syndrome

BACKGROUND

Malnutrition is an independent predictor of adverse outcomes in patients with acute coronary syndrome. The controlling nutritional (CONUT) score has been applied to assess nutritional status, and has been reported to be associated with poor prognosis in patients with heart failure. However, the prognostic impact of the CONUT score in patients with acute coronary syndrome (ACS) remains to be elucidated.

METHODS

We evaluated the CONUT score in 196 patients with ACS who underwent percutaneous coronary intervention. We divided the patients into four groups according to CONUT score (undernutrition degree: normal, CONUT 0-1 (reference); mild, CONUT 2-4; moderate, CONUT 5-8; severe, CONUT 9-12). The endpoint of the present study was composite events including all-cause death, acute coronary syndrome, target vessel revascularization, and stroke.

RESULTS

The median CONUT score was significantly higher in patients with composite events than in those without events (P = 0.0058). Kaplan-Meier analysis revealed that a significantly higher event rate in patients with severe malnutrition (log-rank test, P = 0.0222). In the multivariate Cox proportional hazards analysis, CONUT score was independently associated with composite events after adjustment for confounding factors (adjusted hazard ratio 1.284, 95% confidence interval 1.126-1.457, P = 0.0003).

CONCLUSION

Higher CONUT scores were associated with unfavorable outcomes in patients with ACS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with ACS.

Nutritional status and severity of coronary artery disease

OBJECTIVE

The aim of this study is to evaluate the association between Nutritional Risk Index (NRI), a simple tool to assess nutritional status, and coronary artery disease severity and complexity in patients undergoing coronary angiography.

METHODS

This study is a retrospective analysis of 822 patients undergoing coronary angiography. Patients with previous revascularization were excluded. Gensini and SYNTAX scores were calculated according to the angiographic images to determine atherosclerosis severity. NRI was calculated as follows: NRI = [15.19 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. In patients ≥65 years of age, Geriatric NRI (GNRI) was used instead of NRI. GNRI was calculated as follows: GNRI = [14.89 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. Patients were then divided into three groups as previously reported: NRI < 92, NRI 92-98 and NRI > 98. Gensini and SYNTAX scores were compared between three groups.

RESULTS

The mean age of study population was 61.9 ± 11.1 years. NRI < 92, 92-98, and >98 was measured in 212, 321 and 289 patients, respectively. There was no difference regarding to sex, BMI, smoking, hypertension and diabetes mellitus between three groups. Patients with NRI < 92 had the highest mean Gensini score than the patients with NRI 92-98 and NRI > 98 (38.0 ± 40.6 vs. 31.17 ± 42.4 vs. 25.8 ± 38.4, P = 0.005). Also patients with NRI < 92 had the highest mean SYNTAX score than the patients with NRI 92-98 and NRI > 98 (11.8 ± 12.9 vs. 9.3 ± 12.4 vs. 7.7 ± 11.8, P = 0.001). Also, Gensini score of ≥20 and high SYNTAX score of ≥33 were associated with lower NRI (P < 0.001 and P < 0.001, respectively).

CONCLUSION

In our study, nutritional status evaluated by the NRI was associated with more extensive and complex coronary atherosclerosis in patients undergoing coronary angiography.

Association of Controlling Nutritional Status Score With 2-Year Clinical Outcomes in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND

This study evaluated whether the Controlling Nutritional Status (CONUT) score could predict clinical outcomes in ST elevation myocardial infarction (STEMI) patients.

METHODS

We performed a retrospective cohort study of STEMI patients after primary percutaneous coronary intervention (pPCI). The endpoint was major adverse cardiac event (MACE). Information was obtained from medical records and via telephone calls. Patients were divided into three groups: normal (CONUT score 0-1; n=278), mild-moderate (score 2-4; n=418), and severe (score ≥5; n=55) groups.

RESULTS

During the 24.6±12 months follow-up, MACEs were observed in 65 (8.7%) patients. The incidence of MACEs was 6.1%, 5.5%, and 45.5% in the normal, mild-moderate, and severe group, respectively (p<0.001). Kaplan-Meier curves revealed that patients with a CONUT score ≥5 had the significantly highest rate of MACE, myocardial re-infarction, and vessel revascularisation. In three Cox proportional hazard models, the CONUT scores were unexceptionally associated with MACE, even after adjusting all other variables (hazard ratio, 12.09; 95% confidence interval [CI], 5.09-28.7; p<0.001). The C-statistic of the CONUT score for the prediction of MACE was 0.692 (95% CI, 0.613-0.771; p<0.001), which is close to that of Global Registry of Acute Coronary Events.

CONCLUSIONS

The nutritional status evaluated by the CONUT score can independently predict clinical outcomes in STEMI patients, which suggests that active nutritional management is meaningful for these patients after PCI.

Prognostic nutritional index as a novel marker for prediction of prognosis in patients with peripartum cardiomyopathy

The clinical significance of poor nutritional status in patients with peripartum cardiomyopathy (PPCM) is not clearly understood. Prognostic nutritional index (PNI) is a simple nutritional assessment tool, which was first demonstrated to be valuable in patients with colorectal surgeries. We aimed to investigate the predictive value of PNI in patients with PPCM.A total of 92 patients diagnosed with PPCM were enrolled in this study. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count. The primary endpoint was defined as composite adverse cardiac events that included cardiac death or hospitalization due to worsening heart failure (HF). Cardiac death, hospitalization due to worsening HF, and persistent left ventricular (LV) systolic dysfunction were evaluated, respectively, as secondary endpoints.Primary composite endpoint was higher in the lower PNI group. After adjusting for other risk factors, PNI was found to be as an independent predictor of primary composite endpoint (odds ratio 0.805; 95% confidence interval 0.729-0.888; P < .001). In addition, PNI was significantly associated with secondary endpoints; persistent LV systolic dysfunction as well as cardiac death.This study identified nutritional status assessed by the PNI seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.

Total blood lymphocyte count as a prognostic factor among unselected inpatients

PURPOSE

The aim of this study was to determine the relationships between total lymphocyte count (TLC) and prognosis among inpatients.

PATIENTS AND METHODS

We retrospectively analyzed data from electronic medical documentation of 54 976 inpatients hospitalized in an urban university hospital during 3 consecutive years (2014-2017).

RESULTS

TLC was available for 12 651 (23.01%) of the inpatients. Patients with TLC <0.8 G/L constituted about 15% of the inpatients studied and had the highest risk of death, hospital readmission within 14 days, hospital readmission within 30 days and hospital readmission within 1 year, the lowest values for biochemical parameters of nutritional status assessment, and the highest C-reactive protein levels. An increase in TLC was associated with reduced risk of in-hospital death (odds ratio [OR]; 95% confidence interval [CI]): 0.31; 0.27-0.36 and 14-day readmission: 0.78; 0.72-0.86. The risk of in-hospital death associated with the Nutritional Risk Screening 2002 (NRS-2002) score, blood albumin concentration, and the score for the combined values of hemoglobin, TLC, albumin and neutrophils (HLAN) was (OR; 95% CI): 2.44; 2.35-2.53; 0.32; 0.28-0.36; and 0.96; 0.94-0.97; respectively.

CONCLUSIONS

TLC < 0.8 G/L is associated with the highest risk of in-hospital death, 14-day and 30-day readmission, and longer in-hospital stay. An increase in TLC predicted in-hospital survival and freedom from early readmission with a power similar to or greater than a number of prognostic formulas based on questionnaires (e.g. NRS-2002), biochemical parameters (e.g. albumin) and formulas composed of multiple parameters (e.g. HLAN).

The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Head and Neck Cancer

OBJECTIVE

The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI <82); intermediate (GNRI 82-98); and normal (GNRI >98). The primary endpoint was overall survival.

RESULTS

A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]).

CONCLUSIONS

The GNRI could be considered a useful prognostic factor in patients with AHNC.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E151-E156, 2021.

Malnutrition status in patients of very advanced age with nonvalvular atrial fibrillation and its impact on clinical outcomes

BACKGROUND AND AIMS

Malnutrition is associated with adverse outcomes in patients with chronic disease. We screened malnutrition among patients of very advanced age with nonvalvular atrial fibrillation (AF) by malnutrition scores and investigated the associations between malnutrition and clinical outcomes.

METHODS AND RESULTS

This retrospective observational study included 461 patients aged ≥80 years with nonvalvular AF. Malnutrition was screened using the Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) scores. The primary endpoints were composite events, including thromboembolic events and all-cause death. Malnutrition was present in 62.9%, 5.0%, and 21.9% of patients according to the CONUT, PNI, and GNRI scores, respectively. During a median 27-month follow-up, 130 (28.2%) patients had composite events. Kaplan-Meier curves revealed that patients with moderate to severe malnutrition had the worst clinical outcomes (log-rank P < 0.05 for all scores). Multivariate Cox proportional hazards analysis showed that moderate to severe malnutrition was an independent predictor of composite events [hazard ratio (HR): 2.051, 95% confidence interval (95%CI): 1.143-3.679, P = 0.016 for CONUT score; HR: 3.374, 95%CI: 1.898-5.998, P < 0.001 for PNI score; HR: 2.254, 95%CI: 1.381-3.679, P = 0.001 for GNRI score]. Addition of the CONUT or GNRI score to a baseline prediction model for composite events significantly improved the net reclassification improvement and integrated discrimination improvement (all P < 0.05).

CONCLUSION

Moderate to severe malnutrition was an independent predictor of adverse outcomes among patients of very advanced age with nonvalvular AF. Screening for malnutrition might provide useful information regarding prognosis and risk stratification.

The Baseline Nutritional Status Predicts Long-Term Mortality in Patients Undergoing Endovascular Therapy

Introduction: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospitalized patients. This study aimed to determine the prognostic value of the CONUT score in patients with peripheral artery disease (PAD) who were undergoing endovascular therapy (EVT). METHODS and RESULTS: This study included 628 PAD patients who underwent EVT between 2013 and 2017 and were assigned to low (CONUT score 0: n = 81), mild (CONUT score 1–2: n = 250), moderate (CONUT score 3–4: n = 169), and high (CONUT score ≥ 5: n = 128) risk groups. The study’s primary endpoint was any death. Patients in the groups with higher CONUT scores were more likely to have chronic kidney disease (p < 0.001), impaired left ventricular ejection fractions (p < 0.001), and critical limb ischemia (p < 0.001) on admission. During follow-up, 95 patients (15%) died. Kaplan–Meier analyses revealed that the patients with higher CONUT scores had lower survival rates (p < 0.001; log-rank trend test). Multivariate Cox regression analyses showed that following adjustments for the confounding factors, a higher CONUT score was significantly associated with any death (hazard ratio, 1.15; 95% confidence interval, 1.03–1.30). CONCLUSION: The simple index CONUT score at the time of EVT may predict long-term mortality in PAD patients.

A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support

BACKGROUND

A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have previously proposed a novel nutritional index, which can be calculated using serum levels of triglycerides, total cholesterol, and body weight (TCBI). In this study, to expand the application of TCBI for critical patients, we investigated the usefulness of TCBI to predict prognosis in hemodynamically unstable patients with percutaneously implantable mechanical circulatory support (MCS) devices in the ICU.

PATIENTS AND METHODS

This is a retrospective analysis of a multicenter registry consisting of three Juntendo University hospitals in Japan involving patients who received MCS devices, including intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (VA-ECMO), between 2012 and 2016 (n = 439). The median follow-up period was 298 days.

RESULTS

Spearman's correlation coefficient between TCBI and the geriatric nutritional risk index (GNRI) was 0.44 (p < 0.0001), indicating a moderate positive correlation for these two variables. Unadjusted Kaplan-Meier analysis demonstrated reduced risks of all-cause and cardiovascular mortalities in patients with higher tertiles of TCBI. Furthermore, adjusted multivariate Cox proportional hazard analyses revealed that the highest tertile TCBI was an independent predictor for the reduced risk of all-cause mortality (hazard ratio (HR): 0.22, 95% confidence interval: 0.10-0.48, p < 0.0001) and cardiovascular mortality (0.20, 0.09-0.45, p < 0.0001).

CONCLUSION

A novel and simple to calculate nutritional index, TCBI, can be applicable as a prognostic indicator in hemodynamically unstable patients requiring MCS devices.