Preoperative risk factors of malnutrition for cardiac surgery patients

Abstract

Background.Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients.Materials and methods.The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models.Results.A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416–6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182–2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995–8.389, p < 0.001) and body mass index (OR: 0.928, CI95%: 0.890–0.968, p < 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951–0.983, p < 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002–1.028, p = 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353–6.757, p = 0.007) and mobility (OR: 2.770, CI95%: 1.067–7.194, p = 0.036).Conclusions.MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility and food intake.

The relevance of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentration for postoperative infections and postoperative organ dysfunctions in cardiac surgery patients: The eVIDenCe study

“…CABG surgery patients had significantly higher 25OHD levels than patients undergoing valve or combined surgery. In fact, previous studies showed that malnutrition occurs on average three times more often among patients with heart valve diseases than in patients with coronary heart disease [20]. Heart valve diseases are associated with profound haemodynamic alterations and progressive weak physical condition [21], which may have contributed to the shown low 25OHD levels in these patients.…”

A multidisciplinary team nursing model in the treatment of patients undergoing transapical mitral valve clamping: a prospective study

“…This study found that 60.0% of patients with mitral valve clipping were at risk of malnutrition before surgery. A study of 712 patients undergoing cardiac surgery found that the incidence of malnutrition was 22.9%; Among them, patients with valvular disease, severe heart function transmission, renal insufficiency, and high inflammation indicators were the most prone to malnutrition [ 14 ]. Disease-related malnutrition is a serious problem for patients undergoing cardiac surgery because it not only leads to higher mortality, risk of postoperative infections, and other complications, but it also prolongs hospital stays [ 15 , 16 ].…”

Successful Triple Valve Surgery in an Undernourished Patient: What to Prepare?

“…Malnutrition is often not diagnosed if we only use BMI because of the overload condition, which is a confounding factor for BMI. Drastic changes in body weight are usually caused by overload conditions and response to diuretic therapy, but slower changes in body weight usually indicate changes in nutritional status, especially when accompanied by a stable patient's condition and build-up of muscle mass (Lomivorotov et al, 2013;Ringaitienė et al, 2016;Stoppe et al, 2017).…”