Additional predictive value of nutritional status in the prognostic assessment of heart failure patients

Rovere, Maria Teresa La; Maestri, Roberto; Olmetti, Francesca; Paganini, Vincenzo; Riccardi, Giorgio; Riccardi, Roberto; Pinna, Gian Domenico; Traversi, Egidio

doi:10.1016/j.numecd.2016.09.009

Cited by 32 publications

(31 citation statements)

References 19 publications

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“…Our results showed that all-cause death occurred more frequently in HFpEF patients with moderate or major nutrition-related risk than in those with low or no nutrition-related risk ( Table 3 and Model 4). [7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, to our knowledge, all but one 18 of the previous studies reported on so-called HF patients, and therefore, our specific findings for 'HFpEF patients' are novel. The results of the present study indicate that screening nutritional status using a GNRI at discharge further refines risk assessment in patients hospitalized with HFpEF.…”

Section: Discussionmentioning

confidence: 76%

“…In HF patients, undernutrition is not uncommon [7][8][9][10][11][12][13][14][15] and represents one of the most significant determinants of poor clinical outcomes. [7][8][9][10][11][12][13][14][15][16][17] The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional screening tool for elderly HF patients. [18][19][20] However, the predictive value of the assessment of nutritional status using GNRI in patients with HFpEF remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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Aims The objective of the study was to evaluate whether the geriatric nutritional risk index (GNRI) at discharge may be helpful in predicting the long‐term prognosis of patients hospitalized with heart failure (HF) with preserved ejection fraction (HFpEF, left ventricular ejection fraction ≥50%), a common HF phenotype in the elderly. Methods and results Overall, 110 elderly HFpEF patients (≥65 years) from the Ibaraki Cardiovascular Assessment Study‐HF ( n = 838) were enrolled. The mean age was 78.5 ± 7.2 years, and male patients accounted for 53.6% ( n = 59). All‐cause mortality was compared between the low GNRI (<92) with moderate or severe nutritional risk group and the high GNRI (≥92) with no or low nutritional risk group. Cox proportional hazard regression models were constructed to evaluate the influence of the GNRI on all‐cause death with the following covariates using forward stepwise selection: age, sex, nutritional status based on the GNRI as a categorical variable, history of HF hospitalization, haemoglobin level, estimated glomerular filtration rate, log brain natriuretic peptide levels (logBNP), history of hypertension, log C‐reactive protein levels, left ventricular ejection fraction, left ventricular mass index, and the New York Heart Association functional classification (I/II or III class). The prognostic value of the GNRI was compared with that of serum albumin using C‐statistics. The GNRI was added to the logBNP, serum albumin or the body mass index was added to the logBNP, and the C‐statistic was compared using DeLong's test. Cox regression analysis revealed that age and a low GNRI were independent predictors of all‐cause death ( P < 0.05, n = 103; hazard ratio = 1.095, 95% confidence interval = 1.031–1.163, for age, and hazard ratio = 3.075, 95% confidence interval = 1.244–7.600, for the GNRI). DeLong's test for the two correlated receiver operating characteristic curves [area under the receiver operating characteristic curve (AUROC) of serum albumin, 0.71; AUROC of the GNRI, 0.75] demonstrated significant differences between the groups ( P = 0.038). Adding the GNRI to the logBNP increased the AUROC for all‐cause death significantly (0.71 and 0.80, respectively; P = 0.040, n = 105). The addition of serum albumin or the body mass index to the logBNP did not significantly increase the AUROC for all‐cause death ( P = 0.082 and P = 0.29, respectively). Conclusions Nutritional screening using the GNRI at discharge is helpful to predict the long‐term prognosis of elderly HFpEF patients.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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“…Prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) scores, and g eriatric n utritional r isk i ndex (GNRI) were adopted to assess the individual's nutritional status, where PNI = 10 × serum albumin (SA) (g/dL)+0.005 × total lymphocyte count (TLC) (×10 3 /µL). CONUT score was determined by assessing the circulating levels of three laboratory markers, SA, TLC, and total cholesterol, and GNRI was calculated by the following formula: GNRI = [1.489 × albumin (g/L)]+[41.7 × (weight/WLo)], where WLo represents ideal weight calculated by the Lorentz formula . Patients were categorized as having either better nutrition or malnutrition status according to the level of each nutritional index using previously reported cut‐offs of 3.5 g/dL for SA level, 38 for PNI, 3 for CONUT score, and 92 for GNRI .…”

Section: Methodsmentioning

confidence: 99%

“…CONUT score was determined by assessing the circulating levels of three laboratory markers, SA, TLC, and total cholesterol, and GNRI was calculated by the following formula: GNRI = [1.489 × albumin (g/L)]+[41.7 × (weight/WLo)], where WLo represents ideal weight calculated by the Lorentz formula . Patients were categorized as having either better nutrition or malnutrition status according to the level of each nutritional index using previously reported cut‐offs of 3.5 g/dL for SA level, 38 for PNI, 3 for CONUT score, and 92 for GNRI . Patients were stratified by BMI in accordance with recommendations from the Department of Health in Taiwan as follows: normal weight (BMI < 24 kg/m 2 ), overweight (24 ≤ BMI < 27 kg/m 2 ), and obese (BMI ≥ 27 kg/m 2 ) .…”

Section: Methodsmentioning

confidence: 99%

“…Patients with HFpEF, however, exhibit ‘sarcopenic’ obesity, which is characterized by excessive BMI and low muscle mass with multiple co‐morbidities, excessive visceral adiposity, and heightened systemic inflammation . On the other hand, BMI alone fails to incorporate information that accurately describes a condition of protein‐energy wasting and relevant harmful biological effects, which are known to be highly prognostic in HF . While it has been recently proposed that poor nutritional status in the context of hypoalbuminaemia is associated with a risk of death for patients with HFpEF, the beneficial effects of albumin level over the course of HF syndrome (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications

Chien

Lin

et al. 2019

ESC Heart Failure

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AimsThis study aimed to evaluate the prognostic significance of nutritional status in post‐discharge Asians with heart failure with preserved ejection fraction (HFpEF).Methods and resultsWe examined the prognostic implications of body mass index (BMI) and nutritional markers among consecutive patients hospitalized for HFpEF. Nutritional metrics were estimated by serum albumin (SA), prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index. Among 1120 patients (mean age: 77.2 ± 12.6 years, 39.4% men), mean SA levels, PNI, CONUT scores, and geriatric nutritional risk index were 3.3 ± 0.6 g/dL, 40.2 ± 8.7, 5.5 ± 2.1, and 95.9 ± 14.5, respectively. Lean body size, higher white blood cell counts and C‐reactive protein levels, anaemia, and lack of angiotensin blocker use were independently associated with malnutrition (defined by SA < 3.5 g/dL). Higher SA levels [hazard ratio (HR): 0.67 (95% confidence interval, CI: 0.53–0.85)], higher PNI [HR: 0.97 (95% CI: 0.95–0.99)], and higher geriatric nutritional risk index [HR: 0.98 (95% CI: 0.97–0.99)] (all P < 0.05) were all associated with longer survival, with higher CONUT score [HR: 1.08 (95% CI: 1.02–1.13)] exhibited higher mortality in Cox regression models and with higher SA levels/PNI but not BMI further contributing to the reduced rate of re‐hospitalization (both P < 0.05). Categorizing BMI (25 kg/m2 as cut‐off) and nutritional status showed significantly higher mortality rates among patients with lower BMI/malnutrition than among those with BMI/better nutrition (SA level, PNI, and CONUT score, all P < 0.01). Restricted cubic spline regression revealed a marked survival benefit of better nutrition with increasing BMI (adjusted P interaction for both SA level and PNI: <0.001; adjusted P interaction for CONUT score: 0.046).ConclusionsMalnutrition was frequently and strongly associated with systemic inflammation in Asian patients hospitalized for acute HFpEF. Our findings also indicate that nutrition may play a pivotal role in metabolic protection in this population.

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Natriuretic peptides and C‐reactive protein in in heart failure and malnutrition: a systematic review and meta‐analysis

Prokopidis,

Irlik,

Ishiguchi

et al. 2024

ESC Heart Failure

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BackgroundHeart failure (HF) and malnutrition exhibit overlapping risk factors, characterized by increased levels of natriuretic peptides and an inflammatory profile. The aim of this study was to compare the differences in plasma brain natriuretic peptide (BNP), N‐terminal‐pro B‐type natriuretic peptide (NT‐proBNP), and C‐reactive protein (CRP) in patients with HF and malnutrition versus normal nutrition.MethodsFrom inception until July 2023, the databases, PubMed, Scopus, Web of Science, and Cochrane Library were searched. To examine the association among malnutrition [controlling nutritional status (CONUT) score ≥2; Geriatric Nutritional Risk Index (GNRI) score <92] with BNP, NT‐proBNP and CRP in patients with HF, a meta‐analysis using a random‐effects model was conducted (CRD42023445076).ResultsA significant association of GNRI with increased levels of BNP were demonstrated [mean difference (MD): 204.99, 95% confidence interval (CI) (101.02, 308.96, I2 = 88%, P < 0.01)], albeit no statistically significant findings were shown using CONUT [MD: 158.51, 95% CI (−1.78 to 318.79, I2 = 92%, P = 0.05)]. GNRI [MD: 1885.14, 95% CI (1428.76–2341.52, I2 = 0%, P < 0.01)] and CONUT [MD: 1160.05, 95% CI (701.04–1619.07, I2 = 0%, P < 0.01)] were associated with significantly higher levels of NT‐proBNP. Patients with normal GNRI scores had significantly lower levels of CRP [MD: 0.50, 95% CI (0.12–0.88, I2 = 87%, P = 0.01)] whereas significantly higher levels of CRP were observed in those with higher CONUT [MD: 0.40, 95% CI (0.08–0.72, I2 = 88%, P = 0.01)]. Employing meta‐regression, age was deemed a potential moderator between CRP and GNRI.ConclusionsNormal nutrition scores in patients with HF are linked to lower BNP, NT‐proBNP, and CRP levels compared with malnourished counterparts. Despite the significant link between CRP and malnutrition, their relationship may be influenced in older groups considering the sensitivity of GNRI due to ageing factors.

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Additional predictive value of nutritional status in the prognostic assessment of heart failure patients

Cited by 32 publications

References 19 publications

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications

Natriuretic peptides and C‐reactive protein in in heart failure and malnutrition: a systematic review and meta‐analysis

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