Lu Henri, Claggett Brian L, Minamisawa Masatoshi, Ostrominski John W, Foà Alberto, Pabón Maria A, Kalayci Arzu, Vaduganathan Muthiah, Cikes Maja, Shah Amil M, Desai Akshay S, McMurray John J V, Jhund Pardeep S, Packer Milton, Lefkowitz Martin, Rouleau Jean L, Zile Michael R, Zannad Faiez, Hegde Sheila M, Solomon Scott D, Skali Hicham
Division of Cardiovascular Medicine Brigham and Women's Hospital, Harvard Medical School Boston MA USA.
Division of Cardiology Lausanne University Hospital (CHUV), University of Lausanne (UNIL) Lausanne VD Switzerland.
J Am Heart Assoc. 2025 May 6;14(9):e038872. doi: 10.1161/JAHA.124.038872. Epub 2025 Apr 23.
The Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) are indices that identify individuals at risk of malnutrition. Our study sought to examine the incidence and prognostic implications of abnormal CONUT and/or GNRI in patients with heart failure with preserved ejection fraction.
The CONUT score and GNRI were serially analyzed in this post hoc analysis of the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. A CONUT score >2 or GNRI ≤98 was considered to be abnormal. The association between abnormal CONUT and/or GNRI (analyzed using a time-updated approach) and total heart failure hospitalizations and cardiovascular death was analyzed. Other outcomes included cardiovascular death, all-cause death, total heart failure hospitalizations, first all-cause hospitalization, and first noncardiovascular hospitalization. We also explored the effect of incident hospitalization on subsequent incident abnormal CONUT and/or GNRI. In 4794 patients (55% women, mean age 72±8 years), 1119 (23.3%) had at least 1 abnormal score at randomization. Among the remaining 3675 patients, 1405 (38.2%) developed at least 1 abnormal score over a median follow-up of 2.9 years. Any abnormal score during follow-up was associated with a significantly higher risk of fatal and nonfatal outcomes, and all types of hospitalizations (all-cause, heart failure, and noncardiovascular hospitalizations). Among patients with normal scores at randomization, any hospitalization during follow-up was associated with a significantly higher risk of developing at least 1 abnormal score posthospitalization, compared with prehospitalization and never-hospitalized patients (adjusted hazard ratio, 1.37 [95% CI, 1.22-1.55]).
Among patients with heart failure with preserved ejection fraction, the rate of individuals with abnormal CONUT and/or GNRI was high, especially following a heart failure hospitalization, and was linked with excess cardiovascular and noncardiovascular events.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
控制营养状况（CONUT）和老年营养风险指数（GNRI）是用于识别营养不良风险个体的指标。我们的研究旨在探讨射血分数保留的心力衰竭患者中CONUT和/或GNRI异常的发生率及其对预后的影响。
在PARAGON-HF（射血分数保留的心力衰竭患者中血管紧张素受体脑啡肽酶抑制剂与血管紧张素受体阻滞剂全球预后前瞻性比较）试验的这项事后分析中，对CONUT评分和GNRI进行了系列分析。CONUT评分>2或GNRI≤98被视为异常。分析了CONUT和/或GNRI异常（采用时间更新方法分析）与心力衰竭住院总数和心血管死亡之间的关联。其他结局包括心血管死亡、全因死亡、心力衰竭住院总数、首次全因住院和首次非心血管住院。我们还探讨了首次住院对随后出现的CONUT和/或GNRI异常的影响。在4794例患者（55%为女性，平均年龄72±8岁）中，1119例（23.3%）在随机分组时至少有1项异常评分。在其余3675例患者中，1405例（38.2%）在中位随访2.9年期间出现至少1项异常评分。随访期间的任何异常评分均与致命和非致命结局以及所有类型的住院（全因、心力衰竭和非心血管住院）风险显著升高相关。在随机分组时评分正常的患者中，与住院前和从未住院的患者相比，随访期间的任何住院均与住院后出现至少1项异常评分的风险显著升高相关（校正风险比，1.37[95%CI，1.22-1.55]）。
在射血分数保留的心力衰竭患者中，CONUT和/或GNRI异常的个体比例较高，尤其是在心力衰竭住院后，并且与心血管和非心血管事件增加有关。
