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. 2019 Jan 11;1(2):87-93.
doi: 10.1253/circrep.CR-18-0018.

Prognostic Importance of Multiple Nutrition Screening Indexes for 1-Year Mortality in Hospitalized Acute Decompensated Heart Failure Patients

Tomonobu Takikawa  1 , Takuya Sumi  2 , Kunihiko Takahara  3 , Yoshihiro Kawamura  3 , Shioh Ohguchi  3 , Mitsutoshi Oguri  3 , Hideki Ishii  1 , Toyoaki Murohara  1
Affiliations

Prognostic Importance of Multiple Nutrition Screening Indexes for 1-Year Mortality in Hospitalized Acute Decompensated Heart Failure Patients

Tomonobu Takikawa et al. Circ Rep. .

Abstract

Background: The purpose of the study was to evaluate the impact of nutritional status on 1-year mortality in hospitalized patients with acute decompensated heart failure (ADHF). Methods and Results: We enrolled 457 hospitalized ADHF patients. Previously established objective nutritional indexes (controlling nutritional status [CONUT], prognostic nutritional index [PNI], geriatric nutritional risk index [GNRI], and subjective global assessment [SGA]) were evaluated at hospital admission. Malnutrition was defined as CONUT score ≥5, PNI score <38, GNRI score <92, and SGA scores B and C. The frequencies of malnutrition based on CONUT, PNI, GNRI, and SGA were 31.5%, 21.4%, 44.9%, and 27.8%, respectively. All indexes were related to the occurrence of 1-year mortality on univariate Cox regression analysis (P<0.05). We constructed a reference model using age, body mass index, systolic blood pressure, sodium concentration, and renal function on multivariable Cox regression analysis. Adding SGA to the reference model significantly improved both net reclassification improvement (NRI) and integrated discrimination improvement (0.344, P=0.002; 0.012, P=0.049; respectively). Other indexes (CONUT, PNI, and GNRI scores) significantly improved NRI (0.254, P=0.019; 0.273, P=0.013; 0.306, P=0.006; respectively). Conclusions: Nutritional screening assessed at hospital admission was appropriate for the prediction of 1-year mortality in hospitalized patients with ADHF.

Keywords: Acute heart failure; Nutrition assessment; Prognosis.

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Conflict of interest statement

H.I. received lecture fees from Astellas Pharma, Bayer Pharmaceutical, Daiichi-Sankyo Pharms, and MSD. T.M. received lecture fees from Bayer Pharmaceutical, Daiichi-Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, Novartis Pharma, Pfizer Japan, Sanofi-aventis, and Takeda Pharmaceutical. T.M. also received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma, Daiichi-Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, Novartis Pharma, Otsuka Pharma, Pfizer Japan, Sanofi-aventis, Takeda Pharmaceutical, and Teijin Pharma. The other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Criteria algorithms for nutrition indexes. Malnutrition was defined as CONUT score ≥5, PNI score <38, GNRI score <92, and SGA scores B,C. Malnutrition was shown in reds. CONUT, controlling nutritional status; GNRI, geriatric nutritional risk index; H, height; PNI, prognostic nutritional index; SGA, subjective global assessment.
Figure 2.
Figure 2.
Distribution of malnutrition according to nutrition index. Abbreviations as in Figure 1.
Figure 3.
Figure 3.
Prevalence of malnutrition according to nutrition index and survival status. Abbreviations as in Figure 1.
Figure 4.
Figure 4.
Kaplan-Meier curves for all-cause mortality-free survival up to 1 year according to malnutrition status using (A) CONUT score; (B) PNI score; (C) GNRI score; and (D) SGA. Abbreviations as in Figure 1.
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