The Baseline Nutritional Status Predicts Long-Term Mortality in Patients Undergoing Endovascular Therapy

Abstract

Introduction: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospitalized patients. This study aimed to determine the prognostic value of the CONUT score in patients with peripheral artery disease (PAD) who were undergoing endovascular therapy (EVT). METHODS and RESULTS: This study included 628 PAD patients who underwent EVT between 2013 and 2017 and were assigned to low (CONUT score 0: n = 81), mild (CONUT score 1–2: n = 250), moderate (CONUT score 3–4: n = 169), and high (CONUT score ≥ 5: n = 128) risk groups. The study’s primary endpoint was any death. Patients in the groups with higher CONUT scores were more likely to have chronic kidney disease (p < 0.001), impaired left ventricular ejection fractions (p < 0.001), and critical limb ischemia (p < 0.001) on admission. During follow-up, 95 patients (15%) died. Kaplan–Meier analyses revealed that the patients with higher CONUT scores had lower survival rates (p < 0.001; log-rank trend test). Multivariate Cox regression analyses showed that following adjustments for the confounding factors, a higher CONUT score was significantly associated with any death (hazard ratio, 1.15; 95% confidence interval, 1.03–1.30). CONCLUSION: The simple index CONUT score at the time of EVT may predict long-term mortality in PAD patients.

Intravascular Ultrasound–Guided Interventions for Below-the-Knee Disease in Patients With Chronic Limb-Threatening Ischemia

“…Newer principles of multidisciplinary care have been applied to patients with CLTI, and additional treatments such as hyperbaric oxygen therapy, lipoprotein apheresis, and nutritional interventions were started later in this study. 28,29 This additional care has the potential to influence the results, which need confirmation in larger studies.…”

Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss

“…Several groups have described the use of nutritional indices calculated using multiple parameters to predict both early and longer-term outcomes in patients with PAD. 1–7 However, to the best of our knowledge, there have been no studies of the relationship between preoperative nutritional status assessed using a nutritional index and WH. Therefore, we believe that this is the first study to show a positive relationship between these parameters in patients with tissue loss.…”

“…2 showed that GNRI is independently associated with all-cause mortality in patients with CLI undergoing EVT, and Mizobuchi et al. 5 showed that a CONUT score ≥ 5 is an independent predictor of three-year OS in patients with PAD undergoing EVT. Mii et al.…”

“…Several previous studies have shown that objective nutritional indices, calculated using multiple simple parameters, are associated with the prognosis of patients with PAD. 1–7 However, in the studies conducted to date, death, major amputation, or cardiovascular events were set as the endpoints, and none have described the relationship between nutritional index and wound healing (WH), which is one of the most important goals of treatment for ischemic tissue loss.…”

Association between Body Mass Index and Clinical Outcomes of Peripheral Artery Disease after Endovascular Therapy: Data from K-VIS ELLA Registry

“…A previous study demonstrated that good nutritional status is an independent predictor of better clinical outcomes in patients undergoing EVT. 26) However, there are currently no recommendations for underweight PAD patients to gain weight in order to improve clinical outcomes. Further studies are needed to elucidate the role of increasing muscle, nutritional support, and weight gain on prognosis of PAD in underweight patients.…”