Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy

Abstract

Background: Peripheral artery disease (PAD) is an athero-occlusive disease and a known risk factor for cardiovascular events. The controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI) are objective tools for evaluating malnutrition and are reportedly associated with poor clinical outcomes in patients with fatal diseases. However, the effect of malnutrition on the clinical outcomes in patients with PAD remains unclear. Methods and Results:We enrolled 357 patients with PAD who underwent endovascular therapy. Malnutrition was diagnosed by CONUT score and GNRI as in previous reports. During a median follow-up period of 1,071 days, there were 67 major adverse cardiovascular and leg events (MACLEs). The CONUT score-and GNRI-based malnutrition statuses were identified in 56% and 46% of the patients, respectively. Proportion of malnutrition increased with advancing Fontaine class. The multivariate Cox proportional hazard regression analysis demonstrated that both the CONUT score-and GNRI-based malnutrition status was an independent predictor of MACLEs. The Kaplan-Meier analysis demonstrated that the MACLE ratio increased with deteriorating malnutrition. Finally, the addition of the CONUT score or GNRI to the known risk factors significantly improved the net reclassification index and integrated discrimination index. Conclusions:Malnutrition was common and closely associated with the clinical outcomes in patients with PAD, indicating that it is a novel therapeutic target in the management of these patients. Methods Study PopulationThis was a prospective study of 357 patients who were admitted to hospital for first PAD treatment. PAD was diagnosed in accordance with the ankle-brachial index (ABI) and computed tomographic angiography findings. EVT was performed by experienced cardiologists according sarcopenia in patients with PAD.The aim of the present study was to reveal the clinical significance of malnutrition in patients with PAD. To clarify this, we focused on the CONUT score and examined (1) the prevalence of malnutrition, (2) effect of malnutrition on the clinical outcome, and (3) association between malnutrition and sarcopenia in patients with PAD.

Impact of the Geriatric Nutritional Risk Index on the Long-Term Outcomes of Patients Undergoing Open Bypass for Intermittent Claudication

“…Bouillanne et al stressed the difference between nutrition-related risk and nutritional status and stated that nutrition-related risk suggests the risk of events after treatment. 14 A positive association between the GNRI and the longterm outcomes of patients with PAD was reported by Shiraki et al 8 and Yokoyama et al 9 Shiraki et al showed that the GNRI was independently associated with allcause death and freedom from major amputation in patients after EVT for CLI 8 and Yokoyama et al reported that the GNRI was a positive predictor of major adverse cardiovascular limb events (MACLE) in patients with PAD following EVT, most of whom suffered from CLI. 9 In addition, Yokoyama et al indicated that the controlling nutritional (CONUT) score was also an independent predictor of MACLE.…”

Impact of Geriatric Nutritional Index in Contrast-Induced Nephropathy Developed in Patients with Non-ST Segment Elevation Myocardial Infarction who Underwent Percutaneous Coronary Intervention

“…CIN was previously defined as an increase in baseline serum creatinine level (Cr) 25% or 0.5 mg/ dL within 48-72 h after PCI [1][2][3] . Although, the physiological mechanisms of CIN are not certain, oxidative stress, inflammation, renal medullary hypoxia, and negative effects of contrast media are supposed to be the underlying physiological mechanisms [6][7][8][9] . The previous studies determined that age, DM, heart failure, anemia, chronic (preexisting) kidney disease, hypoalbuminemia, metabolic syndrome, overuse of high osmolar contrast medium, and peripheral vascular disease are predictors of CIN [1][2][3][4][5][6][7][8][9] .…”

“…Although, the physiological mechanisms of CIN are not certain, oxidative stress, inflammation, renal medullary hypoxia, and negative effects of contrast media are supposed to be the underlying physiological mechanisms [6][7][8][9] . The previous studies determined that age, DM, heart failure, anemia, chronic (preexisting) kidney disease, hypoalbuminemia, metabolic syndrome, overuse of high osmolar contrast medium, and peripheral vascular disease are predictors of CIN [1][2][3][4][5][6][7][8][9] . Also, relation between body mass index (BMI) and development of CIN were evaluated in different studies and the results are confounding [1][2][3][4] .…”

“…Geriatric nutritional risk index (GNRI) is a simple tool to identify the nutritional status of subjects. The clinical impact of GNRI has been demonstrated in many diseases [9][10][11][12] . GNRI is calculated using a simple formula that contains albumin and BMI.…”

Decreased Psoas Muscle Computed Tomography Value Predicts Poor Outcome in Peripheral Artery Disease

“…4 We have previously reported that malnutrition is associated with sarcopenia and causes poor prognosis in patients with PAD. 5 Recently, it was reported that changes in not only skeletal muscle mass, but also in skeletal muscle quality are associated with impaired skeletal muscle function and poor prognosis of several types of cancer. [6][7][8] Intramuscular fat deposition is considered to be an important factor for degraded skeletal muscle quality, 9 which is associated with systemic inflammation and inactivity.…”