Nutritional status and risk of all-cause mortality in patients undergoing transcatheter aortic valve replacement assessment using the geriatric nutritional risk index and the controlling nutritional status score

Abstract

Background: Nutritional status, a key marker of patient frailty, is an important prognostic factor after transcatheter aortic valve replacement (TAVR). Few investigations have evaluated the clinical usefulness of nutritional assessment tools for predicting the risk of mortality following TAVR.

Methods: A total of 412 patients with symptomatic severe AS who underwent TAVR between March 2010 and August 2017 were stratified into subgroups by their Geriatric Nutritional Risk Index [GNRI, low ≤ 98 vs. high > 98 (better nutritional status)] and Controlling Nutritional Status (CONUT) score [low ≤ 3 vs. high ≥ 4; (poorer nutritional status)]. The primary study outcome was all-cause mortality at 1 year.

Results: Patients with low GNRI score showed a significantly higher 1-year mortality rate as compared to those with high GNRI score (13.0% vs. 3.2%, respectively; P = 0.001). Similarly, patients with high CONUT score had a significantly higher rate of 1-year mortality than those with low CONUT score (15.7% vs. 6.2%, respectively; P = 0.005). However, in multivariable Cox proportional-hazards models, low GNRI was the only independent predictor of mortality (adjusted hazard ratio, 3.77; 95% confidence interval 1.54-9.20; P = 0.004). Overall, integration of GNRI into conventional risk models of STS score or logistic EuroSCORE resulted in improved predictive value for mortality measured by the net reclassification improvement and the integrated discrimination improvement.

Conclusions: In patients undergoing TAVR, low GNRI (but not high CONUT score) was independently associated with a higher risk of 1-year mortality. Further research is required to determine whether nutritional screening and management can improve clinical outcomes in patients undergoing TAVR.

Keywords: Aortic stenosis; Mortality; Nutritional status; Transaortic valve replacement.