Yoo Tae Kyung, Miyashita Satoshi, Stein Ariella, Wu Michael, Read-Button Lauren Parsly, Kawabori Masashi, Couper Greg S, Saltzman Edward, Vest Amanda R
Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
JHLT Open. 2024 Oct 10;7:100162. doi: 10.1016/j.jhlto.2024.100162. eCollection 2025 Feb.
Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores - geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) - have the strongest mortality association for HT candidates, and whether they are prognostic at the time of HT listing or HT operation.
We reviewed adults listed for primary HT at a single center 1987-March 2022, with survival follow-up to November 2022. We constructed Cox proportional hazards models and restricted cubic spline curves for each risk score at both HT listing and HT operation and inputted HT operation as a time-varying covariate for models commencing at listing. Risk scores were assessed as continuous and binary variables. Weight change between listing and HT was evaluated similarly.
The 1,024 patients [76% male; median age 55 (46-61) years; HT operation = 656] had median follow-up of 4.6 (interquartile range 1.6-8.7) years. As a continuous variable, lower GNRI at HT listing (greater malnutrition risk) was independently associated with higher mortality. As binary variables, higher risk GNRI, PNI or CONUT scores at listing were all associated with higher mortality. Conversely, risk scores at time of HT operation were not associated with subsequent mortality. There was a non-significant trend towards higher mortality with greater weight loss between listing and HT operation.
Malnutrition risk scores showed prognostic utility only at time of HT listing. As a continuous variable, GNRI at HT listing was independently associated with subsequent mortality.
营养不良风险较高与心力衰竭和心脏移植（HT）患者的死亡率相关。我们研究了哪种营养不良风险评分——老年营养风险指数（GNRI）、预后营养指数（PNI）或控制营养状况（CONUT）——与HT候选者的死亡率关联最强，以及它们在HT登记或HT手术时是否具有预后价值。
我们回顾了1987年至2022年3月在单一中心登记进行初次HT的成年人，并随访其生存情况至2022年11月。我们针对HT登记和HT手术时的每个风险评分构建了Cox比例风险模型和受限立方样条曲线，并将HT手术作为从登记开始的模型的时变协变量输入。风险评分作为连续变量和二元变量进行评估。登记和HT之间的体重变化也进行了类似评估。
1024例患者[76%为男性；中位年龄55（46 - 61）岁；HT手术 = 656例]的中位随访时间为4.6（四分位间距1.6 - 8.7）年。作为连续变量，HT登记时较低的GNRI（更高的营养不良风险）与更高的死亡率独立相关。作为二元变量，登记时较高风险的GNRI、PNI或CONUT评分均与更高的死亡率相关。相反，HT手术时的风险评分与随后的死亡率无关。登记和HT手术之间体重减轻越多，死亡率有升高的趋势，但无统计学意义。
营养不良风险评分仅在HT登记时显示出预后价值。作为连续变量，HT登记时的GNRI与随后的死亡率独立相关。
