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Kałużna-Oleksy M, Krysztofiak H, Sawczak F, Kukfisz A, Szczechla M, Soloch A, Cierzniak M, Szubarga A, Przytarska K, Dudek M, Uchmanowicz I, Straburzyńska-Migaj E. Sex differences in the nutritional status and its association with long-term prognosis in patients with heart failure with reduced ejection fraction: a prospective cohort study. Eur J Cardiovasc Nurs 2024; 23:458-469. [PMID: 38170824 DOI: 10.1093/eurjcn/zvad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
AIMS Many studies show the association between malnutrition and poor prognosis in heart failure (HF) patients. Our research aimed to analyse sex differences in patients with HF with reduced ejection fraction (HFrEF), emphasizing nutritional status and the influence of selected parameters on the prognosis. METHODS AND RESULTS We enrolled 276 consecutive patients diagnosed with HFrEF. Nutritional status was assessed using Mini Nutritional Assessment (MNA), geriatric nutritional risk index (GNRI), and body mass index (BMI). The mean follow-up period was 564.4 ± 346.3 days. The analysed group included 81.2% of men. The median age was 58, interquartile range (IQR) 49-64 years. Among all patients, almost 60% were classified as NYHA III or IV. Half of the participants were at risk of malnutrition, and 2.9% were malnourished. During follow-up, 72 (26.1%) patients died. The female sex was not associated with a higher occurrence of malnutrition (P = 0.99) or nutritional risk (P = 0.85), according to MNA. Coherently, GNRI scores did not differ significantly between the sexes (P = 0.29). In contrast, BMI was significantly higher in males (29.4 ± 5.3 vs. 25.9 ± 4.7; P < 0.001). Impaired nutritional status assessed with any method (MNA, GNRI, BMI) was not significantly associated with a worse prognosis. In multivariable analysis, NYHA class, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP), higher N-terminal fragment of proBNP, and higher uric acid were independent of sex and age predictors of all-cause mortality. CONCLUSION There were no sex differences in the nutritional status in the HFrEF patients, apart from lower BMI in females. Impaired nutritional status was not associated with mortality in both men and women.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Agata Kukfisz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Curie-Sklodowska 9, 41-800 Zabrze, Poland
| | - Magdalena Szczechla
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Aleksandra Soloch
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Maria Cierzniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Alicja Szubarga
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Katarzyna Przytarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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Osório AF, Ribeiro ÉCT, Parahiba SM, Forte GC, Clausell NO, Souza GC. Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis. Nutr Res 2023; 120:1-19. [PMID: 37871448 DOI: 10.1016/j.nutres.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).
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Affiliation(s)
- Amanda Farias Osório
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Édina Caroline Ternus Ribeiro
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Suena Medeiros Parahiba
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Nadine Oliveira Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Corrêa Souza
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Food, Nutrition and Health, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Kojima I, Koyama S, Otobe Y, Suzuki M, Tanaka S, Terao Y, Aoki T, Kimura Y, Masuda H, Abe R, Nishizawa K, Yamada M. Combination of low muscle strength and malnutrition is associated with longer length of hospital stay among older patients with heart failure. Heart Lung 2023; 62:9-15. [PMID: 37290139 DOI: 10.1016/j.hrtlng.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Muscle strength and nutritional status are associated with length of hospital stay (LOHS) in older patients with heart failure (HF). OBJECTIVES The purpose of the study was to examine the association of the combination of muscle strength and nutritional status on LOHS in older patients with HF. METHODS This retrospective cohort study included 414 older inpatients with HF (men, 57.2%; median age, 81 years; interquartile range, 75-86 years). Patients were categorized into four groups according to their muscle strength and nutritional status: group 1, high muscle strength and normal nutritional status; group 2, low muscle strength and normal nutritional status; group 3, high muscle strength and malnutrition; and group 4, low muscle strength and malnutrition. The outcome variable was the LOHS, and an LOHS of >16 days was defined as long LOHS. RESULTS Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 1) showed that group 4 was associated with a more significant risk of long LOHS (odds ratio [OR], 3.54 [95% confidence interval, 1.85-6.78]). In the subgroup analysis, this relationship was maintained for the first admission HF group (OR, 4.65 [2.07-10.45]) but not for the HF readmission group (OR, 2.80 [0.72-10.90]). CONCLUSIONS Our results suggest that the long LOHS for older patients with HF at first admission was associated with a combination of low muscle strength and malnutrition but not by either factor individually.
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Affiliation(s)
- Iwao Kojima
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka 583-8555, Japan
| | - Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied health sciences, Yamato University, 2-5-1, Katayama-cho, Suita-city, Osaka, 564-0082, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Takuya Aoki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yosuke Kimura
- College of Science and Engineering, Health and Sports Technology Course, Kanto Gakuin University, 1-50-1 Mutsuura-higashi, Kanazawa-ku, Yokohama 236-8501, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan
| | - Kenya Nishizawa
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
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Cano-García L, Redondo-Rodríguez R, Manrique-Arija S, Domínguez-Quesada C, Crisóstomo Vacas J, Armenteros-Ortiz P, Ruiz-Vilchez D, Martín-Martín JM, García-Studer A, Ortiz-Márquez F, Mena-Vázquez N, Fernández-Nebro A. Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study. Nutrients 2023; 15:3500. [PMID: 37630691 PMCID: PMC10460011 DOI: 10.3390/nu15163500] [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: 07/26/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors. METHODS This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status. RESULTS The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels <3.8 g/L. Patients with impaired nutritional status had poorer quality of life and physical function. The factors associated with compromised nutritional status (OR [95% CI]) were age (1.0 [1.0-1.1]; p = 0.035), DAS28-ESR (1.8 [1.0-3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9-0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0-0.1]; p = 0.014). CONCLUSIONS Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | | | - Juan Crisóstomo Vacas
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
| | - Pedro Armenteros-Ortiz
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Desiree Ruiz-Vilchez
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - José María Martín-Martín
- UGC de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - Aimara García-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
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Balun A, Akgümüş A, Çetin ZG, Demirtaş B. The Prognostic Value of Geriatric Nutritional Risk Index in Evaluating Rehospitalization and One-Year Mortality in Patients With Heart Failure. Cureus 2023; 15:e44460. [PMID: 37791200 PMCID: PMC10544181 DOI: 10.7759/cureus.44460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Malnutrition is frequently observed in patients with heart failure, and malnutrition causes poor prognosis in these patients. Various calculation tools are used to assess malnutrition, with the geriatric nutritional risk index (GNRI) being one that is frequently used. In our study, we aimed to investigate the value of GNRI in assessing one-year mortality and rehospitalization in patients with heart failure. METHOD A total of 196 patients aged 60 years and older were included in this retrospective study. A GNRI ≤ 98 was defined as malnutrition. Patients were divided into two groups: GNRI ≤ 98 (malnutrition) and GNRI > 98 (non-malnutrition). Rehospitalization due to heart failure and mortality were compared between both groups in the one-year follow-up. RESULTS The duration of hospitalization was significantly lower in the malnourished group compared to the non-malnutrition group (11.5 ± 7.5 days vs. 20.9 ± 16.3 days). All-cause mortality was significantly higher in the malnutrition group (30.8% vs. 18.1, p = 0.045). Risk factors were evaluated to predict all-cause death by Cox regression analysis, and GNRI (hazard ratio (HR) = 0.968; 95%CI: 0.942-0.995; p = 0.018) was associated with all-cause mortality. CONCLUSIONS GNRI, which is used as an indicator of malnutrition, is associated with all-cause mortality at one-year follow-up. Higher mortality was observed in the group with low GNRI, but it was observed that this group was hospitalized for less time due to heart failure.
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Affiliation(s)
- Ahmet Balun
- Cardiology, Bandırma Onyedi Eylül University, Balıkesir, TUR
| | - Alkame Akgümüş
- Cardiology, Bandırma Onyedi Eylül University, Balıkesir, TUR
| | - Zehra G Çetin
- Cardiology, Ankara Bilkent City Hospital, Ankara, TUR
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Sato Y, Kumada M, Kawai H, Motoyama S, Sarai M, Nakagawa T, Izawa H. Geriatric nutritional risk index as readmission predictor in older adults with heart failure irrespective of ejection fraction. FUJITA MEDICAL JOURNAL 2023; 9:211-217. [PMID: 37554944 PMCID: PMC10405900 DOI: 10.20407/fmj.2022-028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Malnutrition is associated with an increased risk of hospital readmission for heart failure in patients with acute decompensated heart failure (ADHF). Therefore, evaluation of the nutritional status in patients with ADHF may be important. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are widely used objective indexes for evaluation of the nutritional status. The present study was performed to determine the best nutritional index for predicting the prognosis in older adults with ADHF. METHODS We retrospectively studied 167 older adults (>65 years of age) who were admitted with ADHF from January 2012 to December 2015 and discharged alive. The objective nutritional status was evaluated using the GNRI, CONUT score, and PNI at admission. The endpoint of this study was unplanned hospitalization for worsening heart failure (WHF) within 1 year after discharge. RESULTS During the follow-up period, 58 patients were readmitted for WHF. In the multivariate Cox analysis, only the GNRI (p<0.0001) was independently associated with readmission for WHF among the three nutritional indexes. Kaplan-Meier analysis revealed that patients in the low-GNRI group (<90 as determined by receiver operating characteristic curve analysis) had a significantly greater risk of 1-year hospital readmission for WHF (p<0.0001; hazard ratio, 6.1; 95% confidence interval, 3.5-10.5). CONCLUSION Among the objective nutritional indexes, the GNRI is the best predictor of readmission for WHF within 1 year after discharge in older adults with ADHF.
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Affiliation(s)
- Yoshihiro Sato
- Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Masahiro Kumada
- Division of Cardiology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tsutomu Nakagawa
- Division of Cardiology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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Gao Z, Chen H. Advances in the beneficial effects of nutrition on stroke-related Sarcopenia: A narrative review. Medicine (Baltimore) 2023; 102:e34048. [PMID: 37327307 PMCID: PMC10270533 DOI: 10.1097/md.0000000000034048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
Stroke is one of the most common causes of disability in adults. Sarcopenia is a syndrome characterized by progressive systemic muscle loss and functional decline. The decrease in skeletal muscle mass and muscle function throughout the body after stroke cannot be explained by neurological motor disorders due to brain injury alone, it is considered to be a secondary sarcopenia known as stroke-related sarcopenia. Mounting evidences showed that stroke-related sarcopenia might promote the occurrence and development of sarcopenia through various pathogenesis such as muscle atrophy, dysphagia, inflammation, and malnutrition, etc. At present, the main indicators used to assess malnutrition in patients with stroke-related sarcopenia include temporalis muscle thickness, calf circumference, phase angle, geriatric nutritional risk index and mini-nutritional assessment short-form, etc. Currently, there is no particularly effective method to curb its progression, but supplementation with essential amino acids, whey protein combined with vitamin D, high energy diet, avoiding Polypharmacy, as well as increasing physical activity level and reducing sedentary lifestyle may improve the malnutrition status of stroke patients, and increase the muscle mass and skeletal muscle index, further delay or even prevent the development of stroke-related sarcopenia. This article reviews the latest research progress on the characteristics, epidemiology, pathogenesis and the role of nutrition in stroke-related sarcopenia, so as to provide reference for the clinical treatment and rehabilitation of stroke-related sarcopenia.
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Affiliation(s)
- Zhiqiang Gao
- School of Public Health, Hubei University of Medicine, Shiyan, China
| | - Hongxia Chen
- Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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8
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Balcioglu O, Kahraman Ü, Ertugay S, Engin C, Yagdi T, Ozbaran M. Association of Nutritional Risk Index With Continuous Flow Left Ventricular Assist Device Complications. Transplant Proc 2023; 55:1278-1282. [PMID: 37268536 DOI: 10.1016/j.transproceed.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Studies revealing the relationship between major surgery outcomes and nutritional parameters are increasing daily. Publications demonstrating the relationship between early postoperative success and surgical complications in patients with chronic heart failure and continuous flow left ventricular assist device (cf-LVAD) are limited. The vast majority of patients with advanced chronic heart failure are cachexic, and the reason for this is multifactorial. The aim of this study is to investigate the link between the modified nutritional risk index (NRI) and 6-month survival and complication rates in patients with a cf-LVAD. METHODS This study included statistical analysis of NRI and postoperative parameters of 456 patients with advanced heart failure who had cf-LVAD implantation between 2010 and 2020. RESULTS The results of this study showed a statistically significant difference between mean NRI values and postoperative parameters such as 6-month survival (P = .001), right ventricular failure (P = .003), infection (P = .001), driveline infection (P = .000), and sepsis (P = .000). CONCLUSIONS This study revealed that 6-month postoperative complications and mortality rates of patients with advanced heart failure in patients with cf-LVAD are closely related to malnutrition status. In these patients, nutrition specialist use would be beneficial both preoperatively and postoperatively to increase surveillance and reduce postoperative complications.
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Affiliation(s)
- Ozlem Balcioglu
- Department of Cardiovascular Surgery, Near East University Faculty of Medicine, Nicosia, Turkish Republic Northern Cyprus.
| | - Ümit Kahraman
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Serkan Ertugay
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cagatay Engin
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Ozbaran
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Sharma Y, Horwood C, Shahi R, Hakendorf P, Thompson C. Impact of Malnutrition on Clinical Outcomes of Acutely Hospitalised Heart Failure Patients at Two Tertiary Hospitals in Australia: An Observational Study. Heart Lung Circ 2023; 32:330-337. [PMID: 36428179 DOI: 10.1016/j.hlc.2022.10.011] [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: 05/10/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Malnutrition is common in patients with heart failure (HF) but is often neglected, despite guidelines suggesting that all hospitalised patients should undergo nutritional screening within 24-hours of admission. AIMS This study investigated the nutritional screening rates and determined the immediate and long-term clinical outcomes in patients with HF admitted at two tertiary hospitals in Australia. METHODS Nutritional screening was assessed by the Malnutrition Universal Screening Tool (MUST) completion rates. Patients were classified into two categories based on their MUST scores (0=low malnutrition risk and ≥1=at risk of malnutrition). Propensity-score-matching (PSM) was used to match 20 variables depending upon the risk of malnutrition. Clinical outcomes included the days-alive-and-out-of-hospital at 90 days of discharge (DAOH90), length of hospital stay, in-hospital, 30-day and 180-day mortality and 30-day readmissions. RESULTS There were 5,734 HF admissions between 2013-2020, of whom, only 789 (13.8%) patients underwent MUST screening. The mean (SD) age was 76.2 (14.0) years and 51.9% were males. Five-hundred and fifty-four (554) (70.2%) patients were at low malnutrition risk and 235 (29.8%) at risk of malnutrition. In HF patients, who were at risk of malnutrition, the DAOH90 were lower by 5.9 days (95% CI -11.49 to -0.42, p=0.035) and 180-day mortality was significantly worse (coefficient 0.10, 95% CI 0.02-0.18, p=0.007) compared to those who were at low risk of malnutrition. However, other clinical outcomes were similar between the two groups. CONCLUSION Nutrition screening is poor in hospitalised HF patients and long-term but not short-term clinical outcomes were worse in malnourished HF patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, SA, Australia.
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Rashmi Shahi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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10
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Kundu R, Seeger R, Elfassy MD, Rozenberg D, Ahluwalia N, Detsky ME, Ferreyro BL, Mehta S, Law AD, Minden M, Prica A, Sklar M, Munshi L. The association between nutritional risk index and ICU outcomes across hematologic malignancy patients with acute respiratory failure. Ann Hematol 2023; 102:439-445. [PMID: 36542101 DOI: 10.1007/s00277-022-05064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022]
Abstract
Patients with hematological malignancies (HM) are at risk of acute respiratory failure (ARF). Malnutrition, a common association with HM, has the potential to influence ICU outcomes. Geriatric nutritional risk index (G-NRI) is a score derived from albumin and weight, which reflects risk of protein-energy malnutrition. We evaluated the association between G-NRI at ICU admission and ICU mortality in HM patients with ARF. We conducted a single center retrospective study of ventilated HM patients between 2014 and 2018. We calculated G-NRI for all patients using their ICU admission albumin and weight. Our primary outcome was ICU mortality. Secondary outcomes included duration of mechanical ventilation and ICU length of stay. Two hundred eighty patients were admitted to the ICU requiring ventilation. Median age was 62 years (IQR 51-68), 42% (n = 118) were females, and median SOFA score was 11 (IQR 9-14). The most common type of HM was acute leukemia (54%) and 40% underwent hematopoietic cell transplant. Median G-NRI was 87 (IQR 79-99). ICU mortality was 51% (n = 143) with a median duration of ventilation of 4 days (IQR 2-7). Mortality across those at severe malnutrition (NRI < 83.5) was 59% (65/111) compared to 46% (76/164) across those with moderate-no risk (p = 0.047). On multivariable analysis, severe NRI (OR 2.34, 95% CI 1.04-5.27, p = 0.04) was significantly associated with ICU mortality. In this single center, exploratory study, severe G-NRI was prognostic of ICU mortality in HM patients admitted with respiratory failure.
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Affiliation(s)
- Riddhi Kundu
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Rena Seeger
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Michael D Elfassy
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Nanki Ahluwalia
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Michael E Detsky
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Arjun Datt Law
- Division of Medical Oncology/Hematology, Department of Medicine, Malignant HematologyPrincess Margaret Cancer Center, Toronto, Canada
| | - Mark Minden
- Division of Medical Oncology/Hematology, Department of Medicine, Malignant HematologyPrincess Margaret Cancer Center, Toronto, Canada
| | - Anca Prica
- Division of Medical Oncology/Hematology, Department of Medicine, Malignant HematologyPrincess Margaret Cancer Center, Toronto, Canada
| | - Michael Sklar
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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11
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Mohamad Alahmad MA, Acharya P, Gibson CA, Wiley M, Hockstad E, Gupta K. Cachexia Is Associated With Adverse Outcomes in Patients Admitted With Heart Failure. Am J Cardiol 2023; 186:30-35. [PMID: 36343443 DOI: 10.1016/j.amjcard.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Cachexia is often seen in patients with heart failure (HF). This study aimed to examine the association between cachexia and clinical outcomes in patients hospitalized for HF. We extracted all adult cases with a primary diagnosis of HF that were discharged between January and November, identified in the Nationwide Readmissions Database for 2016 through 2019. Exclusion criteria included cases with missing data or a diagnosis of acquired immunodeficiency syndrome, advanced liver disease, end-stage renal disease, chronic lung disease, or malignancy. Appropriate weighting was used to obtain national estimates. Primary outcomes were inpatient mortality, length of stay, and 30-day readmission in patients with HF with cachexia compared with patients with no cachexia. Multivariable logistic regression was used to estimate the association between cachexia and clinical outcomes. Survey procedures were applied using Statistical Analysis Software 9.4. The final analysis included 2,360,307 HF-related hospitalizations. Cachexia was present in about 7% of the study population. A greater percentage of patients with cachexia were female and older than patients without cachexia (52% vs 47% female, the mean age of 77 vs 72 years, respectively). However, after adjusting for demographics and co-morbidities, including coronary artery disease and atrial fibrillation, patients with cardiac cachexia had higher inpatient mortality (odds ratio 3.01, 95% confidence interval 2.88 to 3.15, p <0.001), prolonged hospital stays (9 vs 5 days, p <0.0001), and greater all-cause 30-day readmissions (23% vs 21%, p <0.0001). HF-related cachexia is associated with increased inpatient mortality, greater resource use, and additional healthcare costs.
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Affiliation(s)
| | - Prakash Acharya
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Hockstad
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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12
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Okada T, Mikamo T, Hamamoto W, Iwamoto T, Okamoto T, Maeda K, Yanagitani A, Tanaka K, Isomoto H, Yamaguchi N. Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors. Cancers (Basel) 2022; 14:cancers14225555. [PMID: 36428648 PMCID: PMC9688376 DOI: 10.3390/cancers14225555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.
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Affiliation(s)
- Tomoyuki Okada
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
- Correspondence: ; Tel.: +0857-26-2271
| | - Tsuyoshi Mikamo
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Wataru Hamamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Taku Iwamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kazunori Maeda
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kiwamu Tanaka
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, Nagasaki 852-8501, Japan
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13
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Jang JH, Kim T, Yeo HJ, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K. Impact of nutrition and physical activity on outcomes of hospital-acquired pneumonia. Sci Rep 2022; 12:15605. [PMID: 36114344 PMCID: PMC9481870 DOI: 10.1038/s41598-022-19793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty is an important risk factor for adverse health-related outcomes. It is classified into several phenotypes according to nutritional state and physical activity. In this context, we investigated whether frailty phenotypes were related to clinical outcome of hospital-acquired pneumonia (HAP). During the study period, a total of 526 patients were screened for HAP and 480 of whom were analyzed. The patients were divided into four groups according to physical inactivity and malnutrition: nutritional frailty (Geriatric Nutritional Risk Index [GNRI] < 82 and Clinical Frailty Scale [CFS] ≥ 4), malnutrition (GNRI < 82 and CFS < 4), physical frailty (GNRI ≥ 82 and CFS ≥ 4), and normal (GNRI ≥ 82 and CFS < 4). Among the phenotypes, physical frailty without malnutrition was the most common (39.4%), followed by nutritional frailty (30.2%), normal (20.6%), and malnutrition (9.8%). There was a significant difference in hospital survival and home discharge among the four phenotypes (p = 0.009), and the nutritional frailty group had the poorest in-hospital survival and home discharge (64.8% and 34.6%, respectively). In conclusion, there were differences in clinical outcomes according to the four phenotypes of HAP. Assessment of frailty phenotypes during hospitalization may improve outcomes through adequate nutrition and rehabilitation treatment of patients with HAP.
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14
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da Silva BR, Rufato S, Mialich MS, Cruz LP, Gozzo T, Jordao AA. An Evaluation of Metabolic, Dietetic, and Nutritional Status Reveals Impaired Nutritional Outcomes in Breast Cancer Patients. Nutr Cancer 2022; 74:3611-3622. [PMID: 35762504 DOI: 10.1080/01635581.2022.2093388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Nutritional status can change in breast cancer patients after treatment. However, the metabolic implications of those alterations are poorly understood. We used a cross-sectional study design to compare body composition, lipids, glucose levels, and adiposity indices in breast cancer patients with a matched control and a healthy group. We recruited women who completed their chemotherapy (BC group) and compared them with a group of women without cancer age and body mass index-paired (MC group) and a group of healthy women (HC group). We estimated body composition by bioelectrical impedance analysis, physical function by handgrip strength, and food consumption by 24-hour food record. A blood sample was collected. We calculated visceral obesity indices (VAI and LAP) and insulin resistance-triglyceride glucose (TyG). Eighty-eight women were included (BC = 36, MC = 36, HC = 16). BC patients demonstrated worse phase angle values, nutritional risk index and lower handgrip strength. Additionally, according to the indices, BC had impairments in lipids, worse glucose levels, and elevated visceral fat adiposity and presented important unhealthy dietary patterns characterized by under-recommended protein consumption and higher caloric intake than the other groups. No differences were observed between both control groups. Further investigations are required to examine the underlying mechanisms and the potential longitudinal changes during surveillance.
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Affiliation(s)
- Bruna Ramos da Silva
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Sarah Rufato
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Mirele S Mialich
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Loris P Cruz
- Nursing School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Thais Gozzo
- Nursing School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alceu A Jordao
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
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15
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Nakanishi N, Kaikita K, Ishii M, Kuyama N, Tabata N, Ito M, Yamanaga K, Fujisue K, Hoshiyama T, Kanazawa H, Hanatani S, Sueta D, Takashio S, Arima Y, Araki S, Usuku H, Nakamura T, Suzuki S, Yamamoto E, Soejima H, Matsushita K, Tsujita K. Malnutrition-associated high bleeding risk with low thrombogenicity in patients undergoing percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2022; 32:1227-1235. [PMID: 35197212 DOI: 10.1016/j.numecd.2022.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/04/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Although antithrombotic treatments are established for coronary artery disease (CAD), they increase the bleeding risk, especially in malnourished patients. The total thrombus-formation analysis system (T-TAS) is useful for the assessment of thrombogenicity in CAD patients. Here, we examined the relationships among malnutrition, thrombogenicity and 1-year bleeding events in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS This was a retrospective analysis of 300 consecutive CAD patients undergoing PCI. Blood samples obtained on the day of PCI were used in the T-TAS to compute the thrombus formation area under the curve. We assigned patients to two groups based on the geriatric nutritional risk index (GNRI): 102 patients to the lower GNRI group (≤98), 198 patients to the higher GNRI group (98<). The primary endpoint was the incidence of 1-year bleeding events defined by Bleeding Academic Research Consortium criteria types 2, 3, or 5. The T-TAS levels were lower in the lower GNRI group than in the higher GNRI group. Kaplan-Meier analysis showed worse 1-year bleeding event-free survival in the lower GNRI group compared with the higher GNRI group. The combined model of the GNRI and the Academic Research Consortium for High Bleeding Risk (ARC-HBR) had good calibration and discrimination for bleeding risk prediction. In addition, having a lower GNRI and ARC-HBR positivity was associated with 1-year bleeding events. CONCLUSION A lower GNRI could reflect low thrombogenicity evaluated by the T-TAS and determine bleeding risk in combination with ARC-HBR positivity.
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Affiliation(s)
- Nobuhiro Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan.
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoto Kuyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoru Suzuki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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16
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Jafari-Vayghan H, Moludi J, Saleh-Ghadimi S, Enamzadeh E, Seyed-Mohammadzad MH, Alizadeh M. Impact of Melatonin and Branched-Chain Amino Acids Cosupplementation on Quality of Life, Fatigue, and Nutritional Status in Cachectic Heart Failure Patients: A Randomized Controlled Trial. Am J Lifestyle Med 2022; 16:130-140. [PMID: 35185435 PMCID: PMC8848111 DOI: 10.1177/1559827619874044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/23/2024] Open
Abstract
Background: Cardiac cachexia (CC) adversely affects the lifestyle of heart failure (HF) patients. The current study examined the impact of melatonin cosupplementation and branched-chain amino acids (BCAAs) on quality of life (QoL), fatigue, and nutritional status in cachectic HF patients. Methods: In this trial, 84 CC patients were randomized to melatonin, BCAAs, or coadministration (both) as intervention groups and a control group over 8 weeks. At baseline and postintervention, QoL, fatigue, and nutritional status were assessed. Results: After intervention, improvement in the overall and physical dimensions of QoL and appetite score were found to be statistically significant in the BCAAs (P < .001) and the melatonin+BCAAs (P < .001) groups compared with the placebo group. The emotional dimension score was significantly lower in the BCAAs group compared with the placebo group (P = .001). There was a statistically significant improvement in fatigue severity in all 3 intervention groups compared with the placebo group. The nutrition risk index (NRI) score increased significantly only in the melatonin group (P = .015), and there was no significant difference between the other groups (P = .804). Conclusions: Cosupplementation with BCAAs and melatonin improved QoL, fatigue status, and appetite in cachectic HF patients but did not affect NRI.
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Affiliation(s)
- Hamed Jafari-Vayghan
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Jalal Moludi
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Sevda Saleh-Ghadimi
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Elgar Enamzadeh
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Mir Hossein Seyed-Mohammadzad
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Mohammad Alizadeh
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
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17
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Miura M, Okuda S, Murata K, Nagai H, Ueyama T, Nakao F, Shimokawa M, Yamamoto T, Ikeda Y. Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation. Front Cardiovasc Med 2021; 8:764528. [PMID: 34926615 PMCID: PMC8674489 DOI: 10.3389/fcvm.2021.764528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR. Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint. Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints. Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.
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Affiliation(s)
- Masakazu Miura
- Department of Rehabilitation, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.,Division of Nursing and Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shinichi Okuda
- Ultrasonography Center, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.,Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Kazuhiro Murata
- Department of Rehabilitation, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Hitoshi Nagai
- Ultrasonography Center, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Takeshi Ueyama
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Mototsugu Shimokawa
- Division of Nursing and Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takeshi Yamamoto
- Division of Nursing and Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasuhiro Ikeda
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
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18
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Passantino A, Guida P, Rizzo C, Carbonara R, Ruggieri R, Scrutinio D. Malnutrition in patients admitted to in-hospital cardiac rehabilitation: Clinical correlates and association with mortality. Monaldi Arch Chest Dis 2021; 92. [PMID: 34818883 DOI: 10.4081/monaldi.2021.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Malnutrition is highly prevalent among hospitalized patients; thus, an accurate identification of malnutrition could improve the outcome of these patients. The aim of the present paper was to apply multiple methods to evaluate the prevalence of malnutrition and clinical correlates in patients admitted to in-hospital cardiac rehabilitation. We performed a prospective study of 426 patients admitted to in-hospital cardiac rehabilitation: 282 (66.2%) had undergone a major cardiac surgery and 144 (34.8%) had experienced heart failure. The albumin level and Mini Nutritional Assessment (MNA) scores were applied to evaluate the nutritional status of these patients. Serum albumin levels were < 3.5 g/dl in 147 (34.5%) patients, and MNA scores were < 24 in 179 (42.0%) patients. Patients with malnutrition or a risk of malnutrition had lower haemoglobin values, lower EuroQol scores and poorer functional status. Female gender, age, functional status and Cumulative Illness Rating Scale severity were predictors of malnutrition. Over a median follow-up of 47 months, MNA scores <24 were associated with higher mortality, even after correction for confounding variables. In conclusion, in patients admitted to in-hospital cardiac rehabilitation, malnutrition and risk of malnutrition frequently occur and are associated with poor functional status, higher clinical complication rates and long-term mortality.
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Affiliation(s)
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari.
| | - Caterina Rizzo
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari.
| | - Rosa Carbonara
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari.
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Koelfat KV, Picot D, Chang X, Desille‐Dugast M, van Eijk HM, van Kuijk SM, Lenicek M, Layec S, Carsin M, Dussaulx L, Seynhaeve E, Trivin F, Lacaze L, Thibault R, Schaap FG, Olde Damink SW. Chyme Reinfusion Restores the Regulatory Bile Salt-FGF19 Axis in Patients With Intestinal Failure. Hepatology 2021; 74:2670-2683. [PMID: 34133768 PMCID: PMC8596508 DOI: 10.1002/hep.32017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Automated chyme reinfusion (CR) in patients with intestinal failure (IF) and a temporary double enterostomy (TDE) restores intestinal function and protects against liver injury, but the mechanisms are incompletely understood. The aim was to investigate whether the beneficial effects of CR relate to functional recovery of enterohepatic signaling through the bile salt-FGF19 axis. APPROACH AND RESULTS Blood samples were collected from 12 patients, 3 days before, at start, and 1, 3, 5, and 7 weeks after CR initiation. Plasma FGF19, total bile salts (TBS), 7-α-hydroxy-4-cholesten-3-one (C4; a marker of bile salt synthesis), citrulline (CIT), bile salt composition, liver tests, and nutritional risk indices were determined. Paired small bowel biopsies prior to CR and after 21 days were taken, and genes related to bile salt homeostasis and enterocyte function were assessed. CR induced an increase in plasma FGF19 and decreased C4 levels, indicating restored regulation of bile salt synthesis through endocrine FGF19 action. TBS remained unaltered during CR. Intestinal farnesoid X receptor was up-regulated after 21 days of CR. Secondary and deconjugated bile salt fractions were increased after CR, reflecting restored microbial metabolism of host bile salts. Furthermore, CIT and albumin levels gradually rose after CR, while abnormal serum liver tests normalized after CR, indicating restored intestinal function, improved nutritional status, and amelioration of liver injury. CR increased gene transcripts related to enterocyte number, carbohydrate handling, and bile salt homeostasis. Finally, the reciprocal FGF19/C4 response after 7 days predicted the plasma CIT time course. CONCLUSIONS CR in patients with IF-TDE restored bile salt-FGF19 signaling and improved gut-liver function. Beneficial effects of CR are partly mediated by recovery of the bile salt-FGF19 axis and subsequent homeostatic regulation of bile salt synthesis.
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Affiliation(s)
- Kiran V.K. Koelfat
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Denis Picot
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Xinwei Chang
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Mireille Desille‐Dugast
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Hans M. van Eijk
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Martin Lenicek
- Institute of Medical Biochemistry and Laboratory Diagnostics1st Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Sabrina Layec
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Marie Carsin
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Laurence Dussaulx
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Eloi Seynhaeve
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Florence Trivin
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Laurence Lacaze
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Ronan Thibault
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Frank G. Schaap
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands,Department of General, Visceral and Transplantation SurgeryRWTH University Hospital AachenAachenGermany
| | - Steven W.M. Olde Damink
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands,Department of General, Visceral and Transplantation SurgeryRWTH University Hospital AachenAachenGermany
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20
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Lv S, Ru S. The prevalence of malnutrition and its effects on the all-cause mortality among patients with heart failure: A systematic review and meta-analysis. PLoS One 2021; 16:e0259300. [PMID: 34710169 PMCID: PMC8553374 DOI: 10.1371/journal.pone.0259300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Malnutrition has a high occurrence in patients with chronic heart failure (CHF). The prevalence of malnutrition and its impact on all-cause mortality in patients with CHF were assessed using a meta-analysis. METHODS PubMed, Embase, the Cochrane Library, Web of Science, Medline, CBM, CNKI, WANFANG DATA, and VIP databases were searched to collect cross-sectional and cohort studies on malnutrition, and the prevalence and all-cause mortality of patients with CHF were determined. The time of retrieval was from the database establishment to May 2021. Two researchers independently performed screening of the literature, data extraction and assessed the risk of bias in the included studies. Then Stata 16.0 software was used for meta-analysis. RESULTS A total of 10 cross-sectional and 21 cohort studies were included, including 12537 patients with CHF. A meta-analysis demonstrated that the total prevalence of malnutrition in patients with heart failure was 46% (95% confidence interval [CI]: 0.43, 0.49). Compared to patients with non-malnutrition, malnutrition increased the risk of all-cause mortality in patients with CHF (hazard ratio = 2.15, 95% CI [1.89, 2.45], P < 0.05). DISCUSSION Current evidence suggests that the prevalence of malnutrition is high among patients with CHF. The risk of all-cause mortality in such patients can be increased by malnutrition. Therefore, the risk of malnutrition in patients with CHF should be considered to reduce the occurrence of adverse clinical outcomes.
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Affiliation(s)
- Shubin Lv
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Songchao Ru
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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21
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Yan X, Zhang S, Jia J, Yang J, Song Y, Duan H. Exploring the malnutrition status and impact of total parenteral nutrition on the outcome of patients with advanced stage ovarian cancer. BMC Cancer 2021; 21:799. [PMID: 34246241 PMCID: PMC8272298 DOI: 10.1186/s12885-021-08537-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer is a common cancer type in women and is often associated with onset of malnutrition. Total parenteral nutrition (TPN) is a nutritional intervention method that has been reported to have controversial effect on cancer patients. In the present retrospective study, we sought to explore the prevalence of malnutrition assessed by the Nutritional Risk Index (NRI) and its association with survival in advanced stage ovarian cancer patients. We also compared the post-operative outcome of the malnourished patients treated with either TPN or conservative management. RESULTS A total of 415 patients with advanced stage ovarian cancer were separated into 4 nutrition groups based on the NRI scores. We found that a number of factors were significantly different among the 4 nutrition groups, including age, serum albumin level, BMI and NRI; among which serum albumin level and NRI were identified to be independent predictors of progression-free and overall survival. In the moderately and severely malnourished patients, those who were treated with TPN had significantly shorter hospitalization period, lower serum albumin level and lower BMI after surgery. In addition, serum albumin level, use of TPN and number of patients with complications were closely related to the hospital stay duration. CONCLUSION Malnutrition status is closely associated with survival of advanced stage ovarian cancer patients. These patients may benefit from TPN treatment for reduced hospitalization, especially with the onset of hypoalbuminemia.
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Affiliation(s)
- Xin Yan
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, China.
| | - Sanyuan Zhang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junmei Jia
- Department of Oncology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiaolin Yang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yilai Song
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, China
| | - Haoran Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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22
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Appetite and Nutritional Status as Potential Management Targets in Patients with Heart Failure with Reduced Ejection Fraction-The Relationship between Echocardiographic and Biochemical Parameters and Appetite. J Pers Med 2021; 11:jpm11070639. [PMID: 34357106 PMCID: PMC8307226 DOI: 10.3390/jpm11070639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the role of appetite loss and malnutrition in patients with heart failure with reduced ejection fraction (HFrEF). In this prospective, observational, single-center study, we enrolled 120 consecutive adults with HFrEF. We analyzed the selected clinical, echocardiographic, and biochemical parameters. Appetite loss and malnutrition were assessed by CNAQ (Council on Nutrition Appetite Questionnaire) and MNA (Mini Nutritional Assessment)/GNRI (Geriatric Nutritional Risk Index) questionnaires, respectively.Most patients were men (81.7%), mean age was 55.1 ± 11.3 years, and mean left ventricular ejection fraction was 23.9 ± 8.0%. The mean CNAQ score was 28.8 ± 3.9, mean MNA-23.1 ± 2.6, and mean GNRI-113.0 ± 12.3. Based on ROC curves, we showed that a sodium concentration <138 mmol/L had the greatest discriminating power for diagnosing impaired nutritional status (MNA ≤ 23.5) with a sensitivity of 54.5% and specificity of 77.8%. The threshold of HDL <0.97 mmol/L characterized 40.7% sensitivity and 86% specificity, B-type natriuretic peptide >738.6 pg/dL had 48.5% sensitivity and 80.8% specificity, high-sensitivity C-reactive protein >1.8 mg/L had 94.9% sensitivity and 42.9% specificity, and bilirubin >15 µmol/L had 78.2% sensitivity and 56.9% specificity. Nutritional status and appetite assessed by MNA/GNRI and CNAQ questionnaires showed poor correlations with other findings in HFrEF patients.
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23
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Czapla M, Juárez-Vela R, Łokieć K, Karniej P. The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure-A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2). Nutrients 2021; 13:1669. [PMID: 34069058 PMCID: PMC8156051 DOI: 10.3390/nu13051669] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. METHODS We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). RESULTS A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). CONCLUSION The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the "lipid paradox". Higher BMI results were related to a lower risk of death, which may indicate the "obesity paradox".
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Affiliation(s)
- Michał Czapla
- Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.C.); (P.K.)
- Centre for Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Katarzyna Łokieć
- Department of Propaedeutic of Civilization Diseases, Medical University of Lodz, 90-251 Lodz, Poland;
| | - Piotr Karniej
- Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.C.); (P.K.)
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24
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Abba A, Fokam J, Kamgaing RS, Yimga JF, Ka’e AC, Nka AD, Tchouaket MCT, Chenwi CA, Semengue ENJ, Ndjolo A, Sosso SM. Correlation between the immuno-virological response and the nutritional profile of treatment-experienced HIV-infected patients in the East region of Cameroon. PLoS One 2021; 16:e0229550. [PMID: 33983976 PMCID: PMC8118549 DOI: 10.1371/journal.pone.0229550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND HIV management remains concerning and even more challenging in the frame of comorbidities like malnutrition that favors disease progression and mortality in resource-limited settings (RLS). OBJECTIVE To describe the nutritional parameters of antiretroviral therapy (ART) recipients (without nutritional support) with respect to CD4 count and virological failure. METHODS A cross-sectional study was conducted from October to December 2018 among 146 consenting participants enrolled in two health facilities of the East-Region of Cameroon. Socio-demographic data, basic clinical information and treatment history were collected; blood samples were collected by venipuncture for laboratory analysis (HIV-1 viral load, CD4 Tcells measurement and biochemical analysis) performed at the "Chantal Biya" International Reference Center", Yaounde, Cameroon. The nutritional profile was assessed by using anthropometric and biochemical parameters. Data were analyzed using Excel 2016, Graph pad prism version 6; Spearman correlation and Kruskal-Wallis test were used; with p<0.05 considered statistically significant. RESULTS Median [IQR] age was 42 [33-51] years, 76.0% (111/146) were female and median [IQR] duration on ART was 54 [28-86] months. Of these participants, 11.6% (17/146) were underweight based on the body mass index and 4.7% (7/146) were at the stage of advanced weight loss. According to immunovirological responses, 44.5% (65/146) were immunocompromised (CD4<500 cell/μl) and 75.3% (110/146) had an undetectable viremia (<40 copies/mL). CD4 count inversely correlated with total protein concentration (r = -0.18, p = 0.005**). Viremia was inversely correlated with albumin (r = -0.21; p = 0.047*), nutritional risk index (r = -0.28; p = 0.013*), total cholesterol (r = -0.27; p = 0.007**), and positively correlated with total protein (r = 0.27; p<0.001**) concentrations. CONCLUSION In this RLS, with patients having about five years of ART-experience, malnutrition appears to be driven mainly by a poor BMI, indicating that about one of ten patients falls within this severe condition. However, the largely normal nutritional profiles should be interpreted with caution, considering local realities and food support programs in place. The present outcomes highlight the need for monitoring nutritional status of people receiving ART in RLS, toward the design of optimal food interventions.
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Affiliation(s)
- Aissatou Abba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- * E-mail: (AA); (JF)
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- * E-mail: (AA); (JF)
| | - Rachel Simo Kamgaing
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Junie Flore Yimga
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Aude Christelle Ka’e
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Alex Durand Nka
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Michel Carlos Tommo Tchouaket
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Collins Ambe Chenwi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | | | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
| | - Samuel Martin Sosso
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
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Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis. Nutrients 2021; 13:nu13041259. [PMID: 33921207 PMCID: PMC8070444 DOI: 10.3390/nu13041259] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient’s functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient’s perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (β = −0.069), perceived health (β = −0.172), physical domain (β = −0.425), psychological domain (β = −0.432), social domain (β = −0.415), environmental domain (β = −0.317). Malnutrition was a significant independent determinant of QoL in the “perceived health” domain (β = −0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (β = 1.414) and environmental domains (β = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.
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Tonet E, Campana R, Caglioni S, Gibiino F, Fiorio A, Chiaranda G, Zagnoni S, Casella G, Campo G. Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases. J Clin Med 2021; 10:jcm10071508. [PMID: 33916645 PMCID: PMC8038542 DOI: 10.3390/jcm10071508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
- Correspondence: ; Tel.: +3-905-3223-7227; Fax: +3-905-3223-9531
| | - Roberta Campana
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Serena Caglioni
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Federico Gibiino
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Alessio Fiorio
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Piacenza, and Sport Medicine Service, 29121 Piacenza, Italy;
| | - Silvia Zagnoni
- Department of Cardiology, Ospedale Maggiore, 40133 Bologna, Italy; (S.Z.); (G.C.)
| | - Gianni Casella
- Department of Cardiology, Ospedale Maggiore, 40133 Bologna, Italy; (S.Z.); (G.C.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (R.C.); (S.C.); (F.G.); (A.F.); (G.C.)
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Performance of functionality measures and phase angle in women exposed to chemotherapy for early breast cancer. Clin Nutr ESPEN 2021; 42:105-116. [DOI: 10.1016/j.clnesp.2021.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022]
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Martínez-Quintana E, Sánchez-Matos MM, Estupiñán-León H, Rojas-Brito AB, González-Martín JM, Rodríguez-González F, Tugores A. Malnutrition is independently associated with an increased risk of major cardiovascular events in adult patients with congenital heart disease. Nutr Metab Cardiovasc Dis 2021; 31:481-488. [PMID: 33223403 DOI: 10.1016/j.numecd.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown. METHODS AND RESULTS A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17-35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2-4.7) g/dL, the body mass index was 23 (21-27) kg/m2, the NRI was 112 (106-118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5-10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04-1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17-8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93-0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration. CONCLUSIONS A low NRI is independently associated with a significant increased risk of MACE in CHD patients.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain; Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Michelle María Sánchez-Matos
- Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Hiurma Estupiñán-León
- Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ana Beatriz Rojas-Brito
- Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jesús María González-Martín
- Research Unit, Complejo Hospitalario Universitario Insular- Materno Infantil, Las Palmas de Gran Canaria, Spain
| | | | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular- Materno Infantil, Las Palmas de Gran Canaria, Spain
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Almutawa DA, Almuammar M, Elshafie MM, Aljuraiban GS, Alnafisah A, Abulmeaty MMA. Survival and Nutritional Status of Male and Female Heart Transplant Patients Based on the Nutritional Risk Index. Nutrients 2020; 12:nu12123868. [PMID: 33348880 PMCID: PMC7766250 DOI: 10.3390/nu12123868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
Malnutrition among heart-transplant patients may affect survival. The aim was to investigate the survival and nutrition status among male and female heart transplant patients who underwent transplantation, before and 1 year after surgery based on the nutritional risk index (NRI). The medical records of ninety heart-transplant patients (2009–2014) from the King Faisal Specialist Hospital, Riyadh, were reviewed. The assessment included demographic data, anthropometric measurements, and NRI calculation. Moreover, postoperative data included the length of stay and survival. Paired t-test and survival analysis by Kaplan–Meier (KM) curves were used. A total of 90 patients (males 77.78%) were included. The prevalence of malnutrition in the preoperative phase by NRI was 60% (7.78% as severe; 40% as moderate, and 12.22% mild NRI scores). After 1 year, body mass index (BMI) and NRI increased significantly (p < 0.001). Furthermore, NRI was significantly different between men and women (p < 0.01), while KM survival curves were insignificantly different (p = 0.67). Recipients with postoperative moderate or severe nutritional risk (NRI < 97.5) had significantly shorter survival in the first-year post-transplantation (HR = 0.82; 95% CI, 0.75–0.89; p < 0.001). Our findings indicate that the NRI after 1 year of transplant correlated significantly with mortality. Besides, there was no significant gender difference regarding survival; however, malnutrition and low survival were more prominent among women.
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Affiliation(s)
- Deema A. Almutawa
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Health Sciences Department, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - May Almuammar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Mona Mohamed Elshafie
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Al Ghad International College of Applied Medical Sciences, Riyadh 12467, Saudi Arabia
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Alaa Alnafisah
- Clinical Nutrition Department, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia;
| | - Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Obesity Management and Research Unit, Medical Physiology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
- Correspondence: ; Tel.: +966-5-4815-5983
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Bullock AF, Greenley SL, McKenzie GAG, Paton LW, Johnson MJ. Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. Eur J Clin Nutr 2020; 74:1519-1535. [PMID: 32366995 PMCID: PMC7606134 DOI: 10.1038/s41430-020-0629-0] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022]
Abstract
Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03-4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03-3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.
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Affiliation(s)
- Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Kitamura M, Izawa KP, Ishihara K, Yaekura M, Nagashima H, Yoshizawa T, Okamoto N. Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction. Heart Vessels 2020; 36:509-517. [PMID: 33123778 DOI: 10.1007/s00380-020-01718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Takashi Yoshizawa
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Nobuhiro Okamoto
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
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Kałużna-Oleksy M, Krysztofiak H, Migaj J, Wleklik M, Dudek M, Uchmanowicz I, Lesiak M, Straburzyńska-Migaj E. Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up. Nutrients 2020; 12:nu12082330. [PMID: 32759722 PMCID: PMC7468814 DOI: 10.3390/nu12082330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g., natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Correspondence: ; Tel.: +48-535-600-625
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Marta Wleklik
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
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Kim K, Go S, Son HE, Ryu JY, Lee H, Heo NJ, Chin HJ, Park JH. Association between Serum Uric Acid Level and ESRD or Death in a Korean Population. J Korean Med Sci 2020; 35:e254. [PMID: 32686371 PMCID: PMC7371451 DOI: 10.3346/jkms.2020.35.e254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Serum uric acid (SUA) is recognized as a risk factor for chronic kidney disease (CKD) and mortality. However, there is controversy as to whether a high or low level of SUA is related to the risk of CKD progression or death, and whether it differs between males and females. METHODS We included 143,762 adults who underwent voluntary health screening between 1995 and 2009 in Korea. For each sex, we divided participants into sex-specific quintiles according to SUA levels and compared end-stage renal disease (ESRD) incidence and mortality between the groups with low and high SUA levels and those with middle SUA levels. Sex-specific Cox proportional hazard analyses were performed for ESRD and all-cause mortality. RESULTS Among the 143,762 participants, 0.2% (n = 272) developed ESRD. The hazard ratio (HR) of ESRD was higher in the highest (adjusted HR, 2.13; 95% confidence interval [CI], 1.18-3.84) and lowest (adjusted HR, 1.90; 95% CI, 1.02-3.51) SUA quintiles than in the middle SUA quintile in males and the highest SUA quintile in females (adjusted HR, 2.31; 95% CI, 1.10-4.84). Four-point three percent (n = 6,215) of participants died during a mean follow-up period of 157 months. The hazard ratio (HR) of all-cause mortality was higher in the highest SUA quintile than in the middle SUA quintile in males (adjusted HR, 1.15; 95% CI, 1.03-1.28) and females (adjusted HR, 1.17; 95% CI, 1.01-1.35). CONCLUSION Elevated levels of SUA are associated with increased risk for ESRD and all-cause mortality in both sexes. Low levels of SUA might be related to ESRD and death only in males, showing U-shaped associations. Our findings suggest sex-specific associations between SUA levels and ESRD development and mortality.
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Affiliation(s)
- Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Suryeong Go
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Eun Son
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Ju Heo
- Department of Internal Medicine, Seoul National University Hospital Healthcare System, Gangnam Center, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
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Bilgen F, Chen P, Poggi A, Wells J, Trumble E, Helmke S, Teruya S, Catalan T, Rosenblum HR, Cornellier ML, Karmally W, Maurer MS, Hummel SL. Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure. JACC-HEART FAILURE 2020; 8:756-764. [PMID: 32653445 DOI: 10.1016/j.jchf.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF). BACKGROUND Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake. METHODS In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks. RESULTS Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m2); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = -14.6; 95% confidence interval [CI]: -27.3 to -1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3). CONCLUSIONS Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679).
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Affiliation(s)
| | - Peiyu Chen
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Stephen Helmke
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Sergio Teruya
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | | | | | | | - Wahida Karmally
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Mathew S Maurer
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Scott L Hummel
- University of Michigan, Ann Arbor, Michigan; Columbia University, New York, New York.
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Oh J, Liu A, Tran E, Berthelet E, Wu J, Olson RA, Chau N, Bowman A, Hamilton SN. Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo-radiotherapy. Head Neck 2020; 42:2560-2570. [PMID: 32562319 DOI: 10.1002/hed.26315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients receiving chemoradiotherapy for head and neck cancer (HNC) are often malnourished. We assessed the utility of nutritional risk index (NRI) in HNC patients undergoing chemoradiotherapy. METHODS A population-based retrospective review of HNC patients treated with curative chemoradiation was performed. Demographics, anthropometrics, overall survival (OS), and the composite treatment complication rate (G-tube dependence, radiation incompletion, 90-day mortality, and unplanned hospitalization) were collected. RESULTS Two hundred ninety-two patients were identified. Average pretreatment and posttreatment NRI were 110 (SD 3) and 99 (SD 12), respectively (P < .01). Pretreatment NRI risk category, age, ECOG status, and tumor subsites were associated with OS on multivariate analysis. Pretreatment NRI risk category was associated with risk of treatment related complications. CONCLUSIONS There was a significant decrease between pretreatment and posttreatment NRI in HNC patients receiving chemoradiation. Pretreatment NRI risk category may predict OS and composite treatment complications. Investigation of NRI as a prognostic factor is warranted.
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Affiliation(s)
- Justin Oh
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alvin Liu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Eric Berthelet
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Robert A Olson
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Centre for the North, Prince George, British Columbia, Canada
| | - Nicole Chau
- Department of Medical Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Angie Bowman
- Oncology Nutrition, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sarah N Hamilton
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
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Kubota K, Miyanaga S, Iwatani N, Higo K, Tokushige A, Ikeda Y, Ohishi M. Geriatric Nutritional Risk Index Is Associated With Prognosis in Patients With Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension. Circ Rep 2020; 2:372-377. [PMID: 33693255 PMCID: PMC7932812 DOI: 10.1253/circrep.cr-20-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing nutritional risk that predicts prognosis in patients with heart failure. This study evaluated associations between the GNRI at first hospitalization and prognosis in patients with pulmonary artery hypertension (PAH) and those with chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Results: This retrospective investigation included 104 patients with either PAH or CTEPH who were treated at Kagoshima University Hospital in Japan. Patients were divided into a high (≥92) and low (<92) GNRI groups. Body mass index and serum albumin levels were significantly lower in the low GNRI group (P<0.001). Over a median follow-up period of 24 months, the incidence of pulmonary hypertension rehospitalization was higher in the low GNRI group (P=0.04). Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower in the low GNRI group (P=0.002). Low GNRI was significantly associated with a poorer outcome after adjusting for different sets of confounding factors, including: age and sex (P=0.004); age, sex, and PAH (P=0.043); and age, sex, and mean pulmonary artery pressure (P=0.003). Conclusions: The GNRI at first hospitalization is useful for predicting prognosis in PAH and CTEPH patients.
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Affiliation(s)
- Kayoko Kubota
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Sunao Miyanaga
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Noriko Iwatani
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Kenjuro Higo
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Akihiro Tokushige
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Yoshiyuki Ikeda
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Mitsuru Ohishi
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
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Cid-Menéndez A, López-Otero D, González-Ferreiro R, Iglesias-Álvarez D, Álvarez-Rodríguez L, Antúnez-Muiños PJ, Cid-Álvarez B, Sanmartin-Pena X, Trillo-Nouche R, González-Juanatey JR. Predictores e impacto pronóstico de la insuficiencia cardiaca tras el implante percutáneo de válvula aórtica con una prótesis autoexpandible. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hirose S, Miyazaki S, Yatsu S, Sato A, Ishiwata S, Matsumoto H, Shitara J, Murata A, Kato T, Suda S, Matsue Y, Hiki M, Takagi A, Daida H, Kasai T. Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction. J Clin Med 2020; 9:1169. [PMID: 32325805 PMCID: PMC7231029 DOI: 10.3390/jcm9041169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022] Open
Abstract
In patients with heart failure (HF), the impact of the Geriatric Nutritional Risk Index (GNRI) on in-hospital mortality and length of hospital stay remains unclear. We aimed to identify the factors associated with increased in-hospital mortality and longer length of hospital stay considering the GNRI in acute decompensated HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Patients with acute decompensated HF who were admitted to our institution between 2007 and 2011 were investigated. A total of 451 (201, HFrEF; 250, HFpEF) patients were divided into the following: patients with GNRI < 92 and ≥92. In HFrEF, there were no significant differences in in-hospital mortality and length of hospital stay between patients with GNRI < 92 and ≥92 (median (interquartile range), 24.0 (23.8) days and 20.0 (15.0) days, respectively, p = 0.32). In HFpEF, despite no differences in in-hospital mortality, patients with GNRI < 92 had significantly longer length of hospital stay than those with GNRI ≥ 92 (median (interquartile range), 20.0 (22.3) days and 17.0 (16.0) days, respectively, p = 0.04). In HFpEF, GNRI < 92, along with lower hemoglobin, higher B-type natriuretic peptide, and elevated C-reactive protein levels, were the independent factors for longer length of hospital stay. Among patients with acute decompensated HF, assessment of nutritional status with GNRI is useful for stratifying patients at high risk for longer length of hospital stay in HFpEF but not in HFrEF. These observations are particularly important when considering the increasing elderly population and prevalence of HFpEF.
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Affiliation(s)
- Susumu Hirose
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Sakiko Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Akihiro Sato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Ochanomizu KS building #303, 3-3-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Ochanomizu KS building #303, 3-3-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Yuya Matsue
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Ochanomizu KS building #303, 3-3-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Atsutoshi Takagi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (S.H.); (S.Y.); (A.S.); (S.I.); (H.M.); (J.S.); (A.M.); (T.K.); (S.S.); (Y.M.); (M.H.); (A.T.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Ochanomizu KS building #303, 3-3-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Ochanomizu KS building #303, 3-3-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Ling HH, Yeh KY, Ng SH, Wang CH, Lai CH, Wu TH, Chang PH, Chou WC, Chen FP, Lin YC. Determining Malnutrition Assessment Criteria to Predict One-Year Mortality for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy. Nutrients 2020; 12:nu12030836. [PMID: 32245095 PMCID: PMC7146124 DOI: 10.3390/nu12030836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
Study on the impact of pretreatment malnutrition on treatment outcomes in locally advanced head and neck cancer (LAHNC) patients is still lacking. We prospectively collected various malnutrition assessment methods including nutrition indexes, inflammatory biomarkers, and lean body mass index (LBMI) data before treatments. The one year mortality rate was assessed, and the factors associated with this outcome were investigated. Furthermore, the association between malnutrition assessment methods was examined. A total of 113 patients were enrolled. By prognostic stratification based on the prognostic nutritional index (PNI) and platelet-to-lymphocyte ratio (PLR) combination, the low PNI/high PLR group had highest and the high PNI/low PLR group had the lowest mortality rate. Furthermore, the PNI was positively correlated with the LBMI, and the PLR was inversely correlated with the LBMI. PNI and PLR were found to be independent prognostic factors of one year mortality and also associated with the loss of muscle.
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Affiliation(s)
- Hang Huong Ling
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Kun-Yun Yeh
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou & Chang Gung University, Taoyuan 333, Taiwan;
| | - Cheng-Hsu Wang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Chien-Hong Lai
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Tsung-Han Wu
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Pei-Hung Chang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 204, Taiwan (K.-Y.Y.); (C.-H.W.); (C.-H.L.); (T.-H.W.); (P.-H.C.)
| | - Wen-Chi Chou
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou & Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Fang-Ping Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- College of Medicine, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yu-Ching Lin
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung & Chang Gung University, Keelung 204, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 2575); Fax: +886-3-3971936
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Kang MK, Kim TJ, Kim Y, Nam KW, Jeong HY, Kim SK, Lee JS, Ko SB, Yoon BW. Geriatric nutritional risk index predicts poor outcomes in patients with acute ischemic stroke - Automated undernutrition screen tool. PLoS One 2020; 15:e0228738. [PMID: 32053672 PMCID: PMC7017988 DOI: 10.1371/journal.pone.0228738] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Premorbid undernutrition has been proven to have an adverse effect on the prognosis of stroke patients. The evaluation of nutritional status is important, but there is no universally accepted screen methodology. PURPOSE We aimed to use the geriatric nutritional risk index (GNRI) for evaluating the effect of premorbid undernutrition on short-term outcomes in patients with acute ischemic stroke. METHODS A total of 1,906 patients were included for analysis. Baseline characteristics were collected. We evaluated the nutritional status of the patients using the GNRI and body mass index(BMI). The GNRI was calculated as {1.519×serum albumin(g/dL) + 41.7×present weight (kg)/ideal body weight (kg)}. All patients were categorized into four groups on the basis of the GNRI score. RESULTS Among the included patients, 546 patients had an unfavorable outcomes. The proportion of patients with moderate and severe risk, assessed in GNRI, was significantly higher in the unfavorable outcome group compared to the favorable outcome group (33.3% vs 15.0%). The increased risk of premorbid undernutrition was associated with an increased risk of unfavorable outcome in a dose-response manner after adjusting for covariates. CONCLUSIONS This study demonstrated that GNRI was associated with poor prognosis in patients with acute ischemic stroke. GNRI may be used to screen patients at high risk for unfavorable outcome.
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Affiliation(s)
- Min Kyoung Kang
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ki-Woong Nam
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Kyung Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Bolat I, Biteker M. Modified Glasgow Prognostic Score is a novel predictor of clinical outcome in heart failure with preserved ejection fraction. SCAND CARDIOVASC J 2020; 54:174-178. [PMID: 31965867 DOI: 10.1080/14017431.2019.1709656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. Although the modified Glasgow Prognostic Score (mGPS) has been reported to have prognostic value in patients with various cancers, the association between mGPS and prognosis in patients with heart diseases have not been well studied. The aim of this study was to evaluate the predictive value of mGPS in outcomes of patients with heart failure and preserved ejection fraction (HFpEF). Design. We prospectively followed consecutive adult patients with HFpEF admitted to the cardiology outpatient unit. Echocardiographic and laboratory data were recorded at enrolment. mGPS was scored as 0, 1, or 2 based on C-reactive protein (CRP) and albumin levels. Patients with both elevated CRP (>1 mg/dL) and hypoalbuminemia (<3.5 g/dL) are given mGPS of 2, patients with serum CRP ≤ 1 g/dL with or without hypoalbuminemia received scores of 0. Patients with only elevated CRP levels received mGPS of 1. The primary composite endpoint of the study was all-cause mortality or heart failure hospitalization through one year. Results. A total of 315 HFpEF outpatients were included, and 42 (13.3%) reached the primary endpoint at one year of follow-up. Compared to patients without mortality or heart failure-related hospitalization, patients who reached the primary endpoint during follow-up were older, were more likely be symptomatic, had higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and mGPS levels at study entry. Multivariate analysis showed that both NT-proBNP and mGPS were independent predictors of primary composite endpoint. Combining NT-proBNP with mGPS improved its prognostic value with an increase of area under the receiver operating characteristic curve from 0.759 to 0.822 (p = .001). Conclusion. This is the first study which demonstrates that mGPS is a predictor of outcomes in patients with HFpEF.
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Affiliation(s)
- Ismail Bolat
- Department of Cardiology, Fethiye Government Hospital, Fethiye, Turkey
| | - Murat Biteker
- Department of Cardiology, Mugla Sıtkı Kocman University, Faculty of Medicine, Department of Cardiology, Mugla, Turkey
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Kitamura M, Izawa KP, Yaekura M, Mimura Y, Ikeda Y, Nagashima H, Brubaker PH. Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245068. [PMID: 31842307 PMCID: PMC6950285 DOI: 10.3390/ijerph16245068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Kokura Rehabilitation College, Kitakyushu, Kitakyushu 800-0206, Japan;
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: ; Tel.: +81-78-796-4566
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yumi Mimura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yuichi Ikeda
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Peter H. Brubaker
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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Determinants of prolonged hospitalization in patients who underwent trans-femoral transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:431-438. [PMID: 31933659 PMCID: PMC6956457 DOI: 10.5114/aic.2019.90217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has grown to be an alternative treatment for severe symptomatic aortic valve stenosis (AS) in elderly patients. Although TAVI is a less invasive surgery than surgical aortic valve replacement, some patients may require prolonged hospitalization. Aim To find the determinants of prolonged hospitalization in patients who underwent trans-femoral TAVI. Material and methods A total of 94 AS patients who underwent trans-femoral TAVI were included as the final study population, and divided into the conventional hospitalization group (≤ 21 days) (n = 74) and prolonged hospitalization group (> 21 days) (n = 20). We compared clinical characteristics between the two groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization. Results In multivariate logistic regression analysis, moderate or severe mitral regurgitation (OR = 4.49, 95% CI: 1.16-17.47, p = 0.03), taking statins or angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) on admission (statins: OR = 0.13, 95% CI: 0.02-0.71, p = 0.02, ACE inhibitors/ARB: OR = 0.25, 95% CI: 0.06-0.96, p = 0.04), estimated glomerular filtration rate (eGFR) (per 15 ml/min/1.73 m2 incremental) (OR = 0.49, 95% CI: 0.26-0.90, p = 0.02) and current chopsticks user (OR = 0.05, 95% CI: 0.01-0.41, p < 0.01) were significantly associated with prolonged hospitalization. Conclusions Moderate or severe mitral regurgitation was significantly associated with prolonged hospitalization, while current chopsticks user, eGFR (per 15 ml/min/1.73 m2 incremental), taking ACE inhibitors/ARB or statins before the procedure were inversely associated with prolonged hospitalization in patients who underwent trans-femoral TAVI.
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Cid-Menéndez A, López-Otero D, González-Ferreiro R, Iglesias-Álvarez D, Álvarez-Rodríguez L, Antúnez-Muiños PJ, Cid-Álvarez B, Sanmartin-Pena X, Trillo-Nouche R, González-Juanatey JR. Predictors and outcomes of heart failure after transcatheter aortic valve implantation using a self-expanding prosthesis. ACTA ACUST UNITED AC 2019; 73:383-392. [PMID: 31501029 DOI: 10.1016/j.rec.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The purpose of this analysis was to assess the incidence, predictors and prognostic impact of acute heart failure (AHF) after transcatheter aortic valve implantation (TAVI) using a self-expanding prosthesis. METHODS From November 2008 to June 2017, all consecutive patients undergoing TAVI in our center were prospectively included in our TAVI registry. The predictive effect of AHF on all-cause mortality following the TAVI procedure was analyzed using Cox regression models. RESULTS A total of 399 patients underwent TAVI with a mean age of 82.4 ± 5.8 years, of which 213 (53.4%) were women. During follow-up (27.0 ± 24.1 months), 29.8% (n = 119) were admitted due to AHF, which represents a cumulative incidence function of 13.2% (95%CI, 11.1%-15.8%). At the end of follow-up, 150 patients (37.59%) had died. Those who developed AHF showed a significantly higher mortality rate (52.1% vs 31.4%; HR, 1.84; 95%; CI, 1.14-2.97; P = .012). Independent predictors of AHF after TAVI were a past history of heart failure (P = .019) and high Society of Thoracic Surgeons score (P = .004). We found that nutritional risk index and chronic obstructive pulmonary disease were strongly correlated with outcomes in the AHF group. CONCLUSIONS TAVI was associated with a high incidence of clinical AHF. Those who developed AHF had higher mortality. Pre-TAVI AHF and high Society of Thoracic Surgeons score were the only independent predictors of AHF in our cohort. A low nutritional risk index and chronic obstructive pulmonary disease were independent markers of mortality in the AHF group.
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Affiliation(s)
- Adrián Cid-Menéndez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Diego López-Otero
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | | | - Diego Iglesias-Álvarez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Leyre Álvarez-Rodríguez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Pablo J Antúnez-Muiños
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Belén Cid-Álvarez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Xoan Sanmartin-Pena
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Ramiro Trillo-Nouche
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José R González-Juanatey
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Barge-Caballero E, Crespo-Leiro MG. Nutritional Risk in Patients With Advanced Heart Failure. We Know How to Detect It but Can We Correct It? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:601-603. [PMID: 30880129 DOI: 10.1016/j.rec.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Eduardo Barge-Caballero
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Barge-Caballero E, Crespo-Leiro MG. Riesgo nutricional de los pacientes con insuficiencia cardiaca avanzada. Sabemos cómo identificarlo, ¿podemos corregirlo? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Uribarri A, Rojas SV, Hanke JS, Dogan G, Siemeni T, Kaufeld T, Ius F, Goecke T, Rojas-Hernandez S, Warnecke G, Bara C, Avsar M, Haverich A. Valor pronóstico del índice de riesgo nutricional para los candidatos a implante de un dispositivo de asistencia ventricular izquierda de flujo continuo. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Su A, Al'Aref SJ, Beecy AN, Min JK, Karas MG. Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature. Mayo Clin Proc 2019; 94:1304-1320. [PMID: 31272573 DOI: 10.1016/j.mayocp.2019.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
Heart failure represents a clinical syndrome that results from a constellation of disease processes affecting myocardial function. Although recent studies have suggested a declining or stable incidence of heart failure, patients with heart failure continue to have high hospitalization and readmission rates, resulting in a substantial economic and public health burden. We searched PubMed and Google Scholar to identify published literature from 1998 through 2018 using the following keywords: heart failure, readmissions, predictors, prediction models, and interventions. Cited references were also used to identify relevant literature. Developments in the diagnosis and management of patients with heart failure have improved hospitalization and readmission rates in the past few decades. However, heart failure remains the most common cause of hospitalization in persons older than 65 years. As a result, given the enormous clinical and financial burden associated with heart failure readmissions on health care, there has been growing interest in the investigation of mechanisms aimed at improving outcomes and curtailing associated costs of care. Herein, we review the current literature on clinical and socioeconomic predictors of heart failure readmissions, briefly discussing limitations of existing strategies and providing an overview of current technology aimed at reducing hospitalizations.
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Affiliation(s)
- Amanda Su
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Ashley N Beecy
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Cardiology, Weill Cornell Medicine, New York, NY
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Maria G Karas
- Department of Cardiology, Weill Cornell Medicine, New York, NY.
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Martín-Sánchez FJ, Cuesta Triana F, Rossello X, Pardo García R, Llopis García G, Caimari F, Vidán MT, Ruiz Artacho P, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Fernández Pérez C, Gil P, Bueno H, Miró Ò, Matía Martín P, Rodríguez Adrada E, Santos MC, Salgado L, Brizzi BN, Docavo ML, Del Mar Suárez-Cadenas M, Xipell C, Sánchez C, Aguiló S, Gaytan JM, Jerez A, Pérez-Durá MJ, Berrocal Gil P, López-Grima ML, Valero A, Aguirre A, Pedragosa MÀ, Piñera P, LázaroAragues P, Sánchez Nicolás JA, Rizzi MA, Herrera Mateo S, Alquezar A, Roset A, Ferrer C, Llopis F, Álvarez Pérez JM, López Diez MP, Richard F, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Andueza JA, Sevillano Fernández JA, Romero R, Merlo Loranca M, Álvarez Rodríguez V, Lorca MT, Calderón L, Soy Ferrer E, Manuel Garrido J, Martín Mojarro E. Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments. Eur J Intern Med 2019; 65:69-77. [PMID: 31076345 DOI: 10.1016/j.ejim.2019.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Federico Cuesta Triana
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Guillermo Llopis García
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisca Caimari
- Department of Endocrinology, University College London, Hospitals NHS Foundation Trust, London, UK
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Ruiz Artacho
- Department of Internal Medicine, Clínica Universitaria de Navarra, Madrid, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Emergency Department-UCE-UHD, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Cristina Fernández Pérez
- Universidad Complutense de Madrid, Madrid, Spain; Preventive Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Gil
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Héctor Bueno
- Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Pilar Matía Martín
- Universidad Complutense de Madrid, Madrid, Spain; Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Roset
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Ferrer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ferrán Llopis
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Thimmapuram R, Lanka S, Esswein A, Dall L. Correlation of Nutrition with Immune Status in Human Immunodeficiency Virus Outpatients. MISSOURI MEDICINE 2019; 116:336-339. [PMID: 31527985 PMCID: PMC6699812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Malnutrition has been proven to cause poor outcomes in many chronic diseases. We examined the association between malnutrition and immune status in HIV patients. We used the Nutritional Risk Index to evaluate the nutrition in 812 HIV patients, and correlated this variable with viral loads and CD4 counts. We found a significant correlation between nutritional status and immune status.
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Affiliation(s)
- Rashmi Thimmapuram
- Rashmi Thimmapuram, Sree Lanka, and Anthony Esswein, are at the University of Missouri - Kansas City School of Medicine, Kansas City, Mo. Lawrence Dall, MD, is Professor and Assistant Dean of Medical Student Research at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine, Infectious Disease at Truman Medical Center, Kansas City, Mo
| | - Sree Lanka
- Rashmi Thimmapuram, Sree Lanka, and Anthony Esswein, are at the University of Missouri - Kansas City School of Medicine, Kansas City, Mo. Lawrence Dall, MD, is Professor and Assistant Dean of Medical Student Research at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine, Infectious Disease at Truman Medical Center, Kansas City, Mo
| | - Anthony Esswein
- Rashmi Thimmapuram, Sree Lanka, and Anthony Esswein, are at the University of Missouri - Kansas City School of Medicine, Kansas City, Mo. Lawrence Dall, MD, is Professor and Assistant Dean of Medical Student Research at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine, Infectious Disease at Truman Medical Center, Kansas City, Mo
| | - Lawrence Dall
- Rashmi Thimmapuram, Sree Lanka, and Anthony Esswein, are at the University of Missouri - Kansas City School of Medicine, Kansas City, Mo. Lawrence Dall, MD, is Professor and Assistant Dean of Medical Student Research at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine, Infectious Disease at Truman Medical Center, Kansas City, Mo
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