Decreased Nutritional Risk Index is associated with mortality after heart transplantation

Abstract

Introduction Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation. Methods The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all‐cause mortality. Results A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate‐to‐severe malnutrition was associated with increased mortality (HR = 1.18, p < .001, 95%CI: 1.13‐1.24), and post‐transplant renal failure requiring dialysis (OR: 1.13, p < .001, 95%CI: 1.03‐1.23). Conclusion Malnourishment determined by NRI is independently associated with mortality and post‐transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.

Nutrition support for patients on mechanical circulatory support

“…While inadequate MNT in the postoperative course generally increases the risk for iatrogenic malnutrition, pre-existing malnutrition before cardiac surgery procedures also must be considered as risk factor for a prolonged and complicated postoperative course and to identify patients with special need for a specific nutritional intervention (Fig. 1) [9 ▪▪ ,10].…”

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients

“…In patients undergoing liver, kidney, or lung transplant, there is an increased risk of mortality before and after transplant, and an increased length of hospital stay when malnutrition is present. [9][10][11][12] Also, in patients with chronic kidney disease (CKD), malnutrition is associated with a threefold increased risk of hospitalizations during the first year on the kidney transplant waiting list. 13 And in lung transplant recipients, malnutrition has been associated with increased drainage volumes, extended hospital stays, and elevated overall hospitalization expenses.…”

“…The NRl scores categorize patients as (1) not malnourished, defined by NRI ≥ 100; (2) mildly malnourished (97.5-<100); (3) moderately malnourished (83.5-<97.5); and (4) severely malnourished (<83.5). 11,12 NRI might be biased in patients with fluid overload, such as those with kidney, liver, and heart disease; and for patients with liver disease, serum albumin level might be decreased because of decreased hepatic synthesis. In addition, serum albumin level often reflects inflammation instead of nutrition status and is not considered a valid nutrition assessment parameter in general.…”

“…Nutritional Risk Index (NRI) is a simple tool that evaluates serum albumin levels as well as current and usual body weight. The NRl scores categorize patients as (1) not malnourished, defined by NRI ≥ 100; (2) mildly malnourished (97.5–<100); (3) moderately malnourished (83.5–<97.5); and (4) severely malnourished (<83.5) 11,12 …”

Improving nutrition practices for postoperative high‐risk heart transplant and ventricular assist device implant patients in circulatory compromise: A quality improvement pre– and post–protocol intervention outcome study

“…Any preexisting nutritional depletion, cardiac cachexia, or malnutrition is typically exacerbated by the physiological stress of surgery and/or withholding of nutrition support in the early postoperative period 7 . Postoperative moderate to severe malnutrition is associated with poor surgical wound healing, renal failure requiring dialysis, and overall increased mortality after HT 8 . Given the increasing number of patients with advanced heart failure undergoing HT and VAD implant, in addition to institutions taking on more complex procedures in older populations, optimal nutrition support practice tailored to meet the specific needs of this population is a high priority to optimize outcomes.…”