The change in nutritional status is related to cardiovascular events in patients with pacemaker implantation: A 4-year follow-up study

Abstract

BackgroundThe aim of our study was to evaluate changes in nutritional status as measured by the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) scores, and their abilities to predict clinical prognosis in patients with pacemaker implantation (PMI).MethodsA total of 595 patients who underwent permanent PMI from January 2011 to December 2020 were included. PNI and GNRI scores were separately calculated at the beginning day of PMI operation and at the end of 12-month follow-up, and their net changes (Δ) were calculated by PNI or GNRI scores at follow-up minus the corresponding scores on admission. The cohort patients were divided into low risk of malnutritional status (ΔPNI or ΔGNRI scores ≥ 0) and high risk of malnutritional status (ΔPNI or ΔGNRI scores < 0) groups. Primary outcome measure was a composite major adverse cardiovascular event (MCE), defined as heart failure hospitalization (HFH), myocardial infarction (MI), stroke, or death from any cause, presented as hazard ratios (HR) with 95% confidence intervals (CI) calculated by MCE in the crude or multivariate-adjusted Cox Proportional Hazards models. Receiver operating characteristic (ROC) curve analysis was used to compare the differential ability to predict incident MCEs betweenΔPNI andΔGNRI scores.ResultsIn total, 16% of patients developed the MCE during the follow-up. The cumulative event rates determined by Kaplan–Meier analysis were significantly higher in the high risk of malnutritional patients compared to the low risk of malnutritional patients (P < 0.05). Adjusted multivariate analysis showed that decreased PNI scores (HR: 2.228, 95% CI: 1.482–3.350) and decreased GNRI scores (HR: 2.178, 95% CI: 1.439–3.295) were independently associated with favorable outcomes. ROC curve analysis revealed an area under curve (AUC) of 0.586 forΔPNI scores and AUC of 0.592 for ΔGNRI scores, but their predictive abilities were not statistically different.ConclusionEither positive change of PNI or GNRI scores were associated with reduced risk of MCEs in patients with PMI, and they have similar ability to predict clinical cardiometabolic risk. Additional enhancing nutritional status during follow-up may help to prevent unfavorable prognosis in clinical practices.

Prognostic Value of Four Preimplantation Malnutrition Estimation Tools in Predicting Heart Failure Hospitalization of the Older Diabetic Patients with Right Ventricular Pacing

“…Balli et al demonstrated the negative relationship between PNI and pacing-induced cardiomyopathy in patients that underwent PPMI (12). The decreased PNI values relative to the baseline PNI values were independently associated with unfavorable outcomes (35). Likewise, our study demonstrated that moderate-to-severe malnutrition was an independent predictor of HFH.…”

Nutritional Status Predicts the Length of Stay and Mortality in Patients Undergoing Electrotherapy Procedures

“…It is worth noting that the prognostic nutritional index is not only associated with malnutrition but also with proinflammation as it includes total lymphocyte count. Moreover, for cardiovascular patients who underwent pacemaker implantation, the lower nutritional status assessed with the prognostic nutritional index and geriatric nutritional risk index resulted in higher cumulative event rates in long-term 4-year follow-up (heart failure hospitalization, myocardial infarction, stroke, or death from any cause) [ 44 ].…”