Estado nutricional en insuficiencia cardiaca avanzada y receptores de trasplante cardiaco

Handgrip strength in patients with acute decompensated heart failure: Accuracy as a predictor of malnutrition and prognostic value

OBJECTIVES

The aim of this study was to determine whether handgrip strength (HGS) has diagnostic accuracy for malnutrition assessment and whether it is an independent predictor of 90-d mortality in patients with acute decompensated heart failure (ADHF).

METHODS

This cohort study evaluated patients with ADHF within 36 h of hospital admission. Subjective global assessment and handgrip dynamometry were performed and the patients' medical records were analyzed. Mortality was monitored by phone contact and/or medical record search after 90 d. Diagnostic accuracy was tested with receiver operating characteristic (ROC) curves, and survival was tested in a Cox model.

RESULTS

The sample consisted of 161 patients with ADHF who were predominantly male (62%) and older (77%), with a mean age of 68 y (60-75 y) and an ejection fraction of 37.7% ± 16.2%. According to subjective global assessment, 60% were suspected of malnourishment or were moderately or severely malnourished and these patients had lower HGS values than the well-nourished patients (P < 0.001). The ROC curve for HGS was sufficiently accurate to assess malnutrition (area under the curve [AUC] = 0.696; 95% confidence interval [CI], 0.614-0.779; P < 0.001) and had very good accuracy to predict severe malnutrition (AUC = 0.817; 95% CI, 0.711-0.923, P < 0.001). When analyzed by sex, HGS could only accurately detect malnutrition in men, although it could detect severe malnutrition in both men and women. During the 90-d follow-up period, there were 16 deaths (9.9%). An HGS cutoff value of 25.5 kg for men was considered significant for 90-d mortality (hazard ratio, 8.6; 95% CI, 1.1-70.9; P = 0.045).

CONCLUSION

The results suggested that HGS is an independent indicator of malnutrition in patients with ADHF and can serve as a prognostic marker of 3-mo mortality in men.

Decreased Nutritional Risk Index is associated with mortality after heart transplantation

INTRODUCTION

Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation.

METHODS

The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all-cause mortality.

RESULTS

A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate-to-severe malnutrition was associated with increased mortality (HR = 1.18, p < .001, 95%CI: 1.13-1.24), and post-transplant renal failure requiring dialysis (OR: 1.13, p < .001, 95%CI: 1.03-1.23).

CONCLUSION

Malnourishment determined by NRI is independently associated with mortality and post-transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.