Impact of nutritional indices on mortality in patients with heart failure

Abstract

Background: Malnutrition is a common condition that is associated with adverse prognosis in patients with heart failure (HF). The Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI) and controlling nutritional status (CONUT) have all been used as objective indices for evaluating nutritional status. We aimed to clarify the relationship between these nutritional indices and the parameters of inflammatory markers, cardiac function and exercise capacity, as well as to compare the ability of these indexes for predicting mortality.

Methods: We evaluated PNI, GNRI and CONUT in consecutive 1307 patients with HF.

Results: First, there were significant correlations between nutritional indices and the following: C reactive protein; tumour necrosis factor-α; adiponectin; B-type natriuretic peptide; troponin I; inferior vena cava diameter and peak VO₂ (P<0.05, respectively). Second, in the Kaplan-Meier analysis (follow-up 1146 days), all-cause mortality progressively increased from normal to mild, moderate and severe disturbance groups in the indices (log-rank, P<0.01, respectively). In the Cox proportional hazard analysis, each index was an independent predictor of all-cause mortality in patients with HF (P<0.001, respectively). Third, receiver operating curve demonstrated that the areas under the curve of PNI and GNRI were larger than that of CONUT score (P<0.05, respectively).

Conclusion: Patients with HF being malnourished had higher mortality accompanied by higher levels of C reactive protein, tumour necrosis factor-α, adiponectin, B-type natriuretic peptide, troponin I, right-sided volume overload and impaired exercise capacity, rather than left ventricular systolic function. Additionally, PNI and GNRI were superior to CONUT score in predicting mortality in patients with HF.

Keywords: exercise capacity; heart failure; malnutrition; metabolism; nutrition; prognosis.

Figure 1

Patient flow chart. CONUT, controlling nutritional status; GNRI, Geriatric Nutritional Risk Index; PNI, Prognostic Nutritional Index.

Figure 2

Cumulative all-cause mortality stratified by PNI, GNRI and COUNT scores. Kaplan-Meier analysis for all-cause mortality in the indices. CONUT, controlling nutritional status; GNRI, Geriatric Nutritional Risk Index; PNI, Prognostic Nutritional Index.

Figure 3

Receiver operating curve (ROC) to predict mortality in patients with HF (n=691). AUC, area under the curve; CONUT, controlling nutritional status; GNRI, Geriatric Nutritional Risk Index; PNI, Prognostic Nutritional Index.