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Li R, Sidawy A, Nguyen BN. Malnutrition is associated with adverse 30-day outcomes after endovascular repair of abdominal aortic aneurysm. Vascular 2024:17085381241289484. [PMID: 39328150 DOI: 10.1177/17085381241289484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Malnutrition is particularly pertinent in patients undergoing vascular surgery, who frequently present with a high burden of comorbidities and advanced age that can impede nutrient absorption. While previous studies have established that vascular surgery patients with malnutrition had poorer outcomes, the impact of nutritional status in patients undergoing endovascular aneurysm repair (EVAR) has not yet been investigated. Therefore, this study aimed to assess the effect of malnutrition on 30-day outcomes following non-ruptured EVAR. METHODS Patients who had infrarenal EVAR were identified in the ACS-NSQIP targeted database from 2012-2022. Exclusion criteria included age less than 18 years, ruptured aneurysm, and emergency. Malnutrition was defined as patients with preoperative weight loss of greater than 10% decrease in body weight in the 6 months immediately preceding the surgery. A 1:5 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without malnutrition. Thirty-day postoperative outcomes were examined. RESULTS There were 154 (0.94%) patients with malnutrition who went under non-ruptured EVAR. Meanwhile, 16,309 patients without malnutrition went under intact EVAR, where 737 of them were matched to all malnutrition patients. Malnourished patients had more comorbidity burdens. After propensity-score matching, patients with malnutrition had elevated but non-significant 30-day mortality (5.92% vs 2.99%, p = .09). However, malnutrition patients had higher risks of renal complications (2.63% vs 0.68%, p = .04), bleeding requiring transfusion (22.37% vs 14.38%, p = .02), and unplanned reoperation (11.18% vs 4.88%, p = .01), as well as longer length of stay (6.11 ± 7.91 vs 4.44 ± 6.22 days, p < .02). CONCLUSION Patients with malnutrition experienced higher rates of morbidity after non-ruptured EVAR. Targeting malnutrition could be a strategy for preventing complications after EVAR and proper preoperative malnutritional management could be warranted.
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Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anton Sidawy
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
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Zhao A, Wu L, Lin L, Li S, Liao X, Chen L, Lin Y. The geriatric nutritional risk index is related to adverse hospitalization outcomes in individuals undergoing cardiac surgery. Sci Rep 2024; 14:19126. [PMID: 39155300 PMCID: PMC11330975 DOI: 10.1038/s41598-024-69668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
Malnutrition is linked to adverse outcomes in post-cardiac surgery patients. This study investigates the correlation between the Geriatric Nutritional Risk Index (GNRI) and adverse hospital outcomes in patients following cardiac surgery. This retrospective study included elderly patients with heart disease who were admitted to the Department of Cardiology, Fujian Medical University Union Hospital from January 2020 to December 2022. Patients were divided into two groups based on the cut-off value (98 g/dL). Data from 407 patients were assessed, with 278 (68.3%) classified as having nutritional risk and 129 (31.7%) as having no nutritional risk. Notable distinctions were observed in body weight, BMI, and left ventricular ejection fraction (P < 0.05). Laboratory indicators indicated lower levels of serum albumin, lymphocytes, red blood cells, hemoglobin, admission blood glucose, and admission triglyceride in the nutritional risk group (P < 0.05). Neutrophils and serum creatinine were higher in the nutritional risk group (P < 0.05). Poor prognosis was prevalent in the nutrition risk group (64.7%), with higher incidences of adverse outcomes (P < 0.05). Univariate and multivariate studies showed that GNRI < 98 g/dL was an independent predictor of postoperative cardiac surgery. Nutritional risk was an important predictor of adverse hospital outcomes after the surgery.
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Affiliation(s)
- Ani Zhao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Lijun Wu
- Department of Nursing, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lingyu Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Xiaoqin Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian Province, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
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Kataoka H, Suzuki S, Suzuki Y, Sato R, Sano M, Mogi S, Sakamoto A, Suwa K, Naruse Y, Ohtani H, Saotome M, Shimizu M, Odagiri K, Maekawa Y. Association of Malnutrition and High Bleeding Risk with Long-Term Prognosis in Patients with Acute Coronary Syndrome following Percutaneous Coronary Intervention. MEDICINES (BASEL, SWITZERLAND) 2023; 10:62. [PMID: 38132889 PMCID: PMC10744455 DOI: 10.3390/medicines10120062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Malnutrition in cardiovascular disease is associated with poor prognosis, especially in patients with heart failure and acute coronary syndrome (ACS). High bleeding risk is also linked to coronary artery disease prognosis, including ACS. However, whether the extent of malnutrition and high bleeding risk have a cumulative impact on the long-term prognosis of patients with ACS who undergo percutaneous coronary intervention remains unclear. METHODS We analyzed 275 patients with ACS treated with percutaneous coronary intervention. The Controlling Nutritional Status score and Japanese version of the Academic Research Consortium for High Bleeding Risk criteria (J-HBR) were retrospectively evaluated. The primary and secondary outcomes were adjusted using the inverse probability treatment weighting method. RESULTS The prevalence of moderate or severe malnutrition in this cohort was 16%. Kaplan-Meier analysis showed a significantly higher incidence of major adverse cardiovascular and cerebrovascular events in patients who were moderately or severely malnourished than in those who were not. Notably, the incidence of these major events was similar between severely malnourished patients with J-HBR and those without. CONCLUSION Moderate or severe malnutrition has a significant impact on the long-term prognosis of patients with ACS who undergo percutaneous coronary intervention.
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Affiliation(s)
- Hiromitsu Kataoka
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Sayumi Suzuki
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Yuichi Suzuki
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Satoshi Mogi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Atsushi Sakamoto
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
| | - Mikihiro Shimizu
- Center for Clinical Research, Hamamatsu University Hospital, Hamamatsu 431-3192, Japan; (M.S.); (K.O.)
| | - Keiichi Odagiri
- Center for Clinical Research, Hamamatsu University Hospital, Hamamatsu 431-3192, Japan; (M.S.); (K.O.)
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; (H.K.); (S.S.); (Y.S.); (R.S.); (M.S.); (S.M.); (A.S.); (K.S.); (Y.N.); (H.O.); (M.S.)
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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Japanese high bleeding risk criteria status predicts low thrombogenicity and bleeding events in patients undergoing percutaneous coronary intervention. Cardiovasc Interv Ther 2023:10.1007/s12928-023-00920-3. [PMID: 36877333 DOI: 10.1007/s12928-023-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
Although the Japanese high bleeding risk criteria (J-HBR) were established to predict bleeding risk in patients undergoing percutaneous coronary intervention (PCI), the thrombogenicity in the J-HBR status remains unknown. Here, we examined the relationships among J-HBR status, thrombogenicity and bleeding events. This study was a retrospective analysis of 300 consecutive patients who underwent PCI. Blood samples obtained on the day of PCI were used in the total thrombus-formation analysis system (T-TAS) to investigate the thrombus-formation area under the curve (AUC; PL18-AUC10 for platelet chip; AR10-AUC30 for atheroma chip). The J-HBR score was calculated by adding 1 point for any major criterion and 0.5 point for any minor criterion. We assigned patients to three groups based on J-HBR status: a J-HBR-negative group (n = 80), a low score J-HBR-positive group (positive/low, n = 109), and a high score J-HBR-positive group (positive/high, n = 111). The primary end point was the 1-year incidence of bleeding events defined by the Bleeding Academic Research Consortium types 2, 3, or 5. Both PL18-AUC10 and AR10-AUC30 levels were lower in the J-HBR-positive/high group than the negative group. Kaplan-Meier analysis showed worse 1-year bleeding event-free survival in the J-HBR-positive/high group compared with the negative group. In addition, both T-TAS levels in J-HBR positivity were lower in those with bleeding events than in those without bleeding events. In multivariate Cox regression analyses, the J-HBR-positive/high status was significantly associated with 1-year bleeding events. In conclusion, the J-HBR-positive/high status could reflect low thrombogenicity as measured by T-TAS and high bleeding risk in patients undergoing PCI.
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