Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: a comparison with body mass index

Sze, S., Pellicori, P. , Kazmi, S., Rigby, A., Cleland, J. G.F. , Wong, K. and Clark, A. L. (2018) Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: a comparison with body mass index. JACC: Heart Failure, 6(6), pp. 476-486. (doi: 10.1016/j.jchf.2018.02.018) (PMID:29753673)

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Abstract

Objectives: The authors sought to report the prevalence, clinical associations, and prognostic consequences of malnutrition in outpatients with heart failure (HF). Background: Malnutrition may be common in HF and associated with adverse outcomes, but few data exist. Methods: We applied the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) to consecutive patients referred with suspected HF to a clinic serving a local population (n = 550,000). Results: Of 4,021 patients enrolled, HF was confirmed in 3,386 (61% men; median age: 75 years; interquartile range [IQR]: 67 to 81 years, median N-terminal pro–B-type natriuretic peptide [NT-proBNP] 1,103 ng/l [IQR: 415 to 2,631 ng/l]). Left ventricular ejection fraction was <40% in 35% of patients. Using scores for GNRI ≤91, CONUT >4, and PNI ≤38, 6.7%, 10.0%, and 7.5% patients were moderately or severely malnourished, respectively; 57% were at least mildly malnourished by at least 1 score. Worse scores were most strongly related to older age, lower body mass index, worse symptoms and renal function, atrial fibrillation, anemia, and reduced mobility. During a median follow-up of 1,573 days (IQR: 702 to 2,799 days), 1,723 (51%) patients died. For patients moderately or severely malnourished, 1-year mortality was 28% for CONUT, 41% for GNRI, and 36% for PNI, compared with 9% for those with mild malnutrition or normal nutritional status. A model including only age, urea, and logNT-proBNP, predicted 1-year survival (C-statistic: 0.719) and was slightly improved by adding nutritional indices (up to 0.724; p < 0.001) but not body mass index. Conclusions: Malnutrition is common among outpatients with HF and is strongly related to increased mortality.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Sze, S., Pellicori, P., Kazmi, S., Rigby, A., Cleland, J. G.F., Wong, K., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Heart Failure
Publisher:Elsevier
ISSN:2213-1779
ISSN (Online):2213-1787
Published Online:09 May 2018

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