Malnutrition is associated with poor prognosis in heart failure
Shirley Sze, M.B.B.S., from Hull York Medical School in the United Kingdom, and colleagues applied the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) to 550,000 patients referred with suspected heart failure to examine the prognostic consequences of malnutrition.
The researchers confirmed heart failure in 3,386 of 4,021 patients enrolled. Overall, 6.7, 10.0, and 7.5 percent of patients were moderately or severely malnourished using scores for GNRI ≤91, CONUT >4, and PNI ≤38, respectively; 57 percent of participants were at least mildly malnourished by one or more scores. Overall, 51 percent of patients died during a median follow-up of 1,573 days. One-year mortality was 28, 41, and 36 percent for patients moderately or severely malnourished for CONUT, GNRI, and PNI, respectively, compared with 9 percent for those with mild malnutrition or normal nutritional status. One-year survival was predicted by a model including age, urea, and log-N-terminal pro-B-type natriuretic peptide (C-statistic, 0.719); additional of nutritional indices, but not body mass index, slightly improved prediction (C-statistic, up to 0.724).
"Malnutrition is common among outpatients with heart failure and is strongly related to increased mortality," the authors write.
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