Malnutrition as Assessed by Nutritional Risk Index is Associated with Worse Outcome in Patients Admitted with Acute Decompensated Heart Failure: An ACAP-HF Data Analysis

Abstract

Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI) at hospital admission are associated with increased length of hospital stay (LOS) in patients admitted with acute decompensated heart failure (ADHF). Serum albumin levels and lymphocyte counts were retrospectively determined at hospital admission in 1740 consecutive patients admitted with primary and secondary diagnosis of ADHF. The Nutrition Risk Score (NRI) developed originally in AIDS and cancer populations was derived from the serum albumin concentration and the ratio of actual to usual weight, as follows: NRI = (1.519 × serum albumin, g/dL) + {41.7 × present weight (kg)/ideal body weight(kg)}. Patients were classified into four groups as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between nutritional risk category and LOS.Three hundred and eighty-one patients (34%) were at moderate or severe nutritional risk by NRI score. This cohort had lower BMI (24 ± 5.6 kg/m2), albumin (2.8±0.5 g/dL), mean NRI (73.5±9) and lower eGFR (50±33 mL/min per 1.73 m2). NRI for this cohort, adjusted for age, was associated with LOS of 10.1 days. Using the Multiple Logistic regression module, NRI was the strongest predictor for LOS (OR 1.7, 95% CI: 1.58–1.9; P=0.005), followed by TIMI Risk Score [TRS] (OR 1.33, 95% CI: 1.03–1.71; P=0.02) and the presence of coronary artery disease (OR 2.29, 95%CI: 1.03–5.1; P=0.04). Moderate and severe NRI score was associated with higher readmission and death rates as compared to the other two groups.Nutritional depletion as assessed by Nutritional Risk Index is associated with worse outcome in patients admitted with ADHF. Therefore; we recommend adding NRI to further risk stratify these patients.

Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction

“…The prevalence of malnutrition and frailty in our cohort was around 45% and 50% respectively, similar to findings from other studies (34% to 70% 6, 26,27 for malnutrition and 30% to 50% 28 for frailty). Ours is the first paper to compare directly several different indices of malnutrition and frailty in patients hospitalised with HF.…”

Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients

“…The Nutritional Risk Index (NRI), an easily calculated measure that incorporates albumin and body size, predicts mortality in single-center cohorts of ambulatory 12 and hospitalized 13 HF patients. The impact of NRI on mortality risk in advanced HF is unknown.…”

Geriatric Nutritional Risk Index Predicts Functional Dependency and Mortality in Patients With Heart Failure With Preserved Ejection Fraction

“…Considering such a counteracting effect, GNRI as a combined index of albumin and BMI may lead to minimization of the effect of fluid status, and identify nutritional risk better than each of them. 13 indicating that GNRI had the highest predictive value for predicting mortality ( Table 3).…”

“…Aziz et al reported that NRI was associated with the composite endpoints all-cause mortality and HF readmission in patients with acute decompensated HF. 13 Al-Najjar and Clark have also shown that NRI predicts mortality in outpatients with HFrEF. 14 We have further extended previous findings by demonstrating the clinical significance of the GNRI, a modified NRI, in HFpEF patients for the first time.…”