Malnutrition status in patients of very advanced age with nonvalvular atrial fibrillation and its impact on clinical outcomes

Cheng, Nan; Dang, Anhong; Lv, Naqiang; He, Yanru; Wang, Xiao

doi:10.1016/j.numecd.2019.06.021

Cited by 16 publications

(14 citation statements)

References 34 publications

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“…Previous studies supported NRI-defined malnutrition as a reliable predictor of adverse CV events in many patient groups, such as patients with acute or chronic HF ( 12 , 33 , 34 ), patients undergoing aortic valve replacement ( 13 , 35 ), and patients with other systemic diseases ( 14 , 15 , 36 ). Furthermore, several other studies showed that in patients with stable CAD or ACS, lower NRI levels (the lower the NRI levels, the greater the nutritional risk) were associated with in-hospital and long-term adverse CV events after PCI ( 11 , 32 , 37 – 39 ); however, these studies did not specifically investigate the prognostic value of malnutrition in ACS patients with diabetes.…”

Section: Discussionmentioning

confidence: 92%

“…The nutritional risk index (NRI) was developed as a simplified screening tool to assess nutritional status and predict clinical outcomes based on weight, height, and ALB ( 8 ). It has been reported that the malnutrition as defined by NRI was associated with the poor prognosis among patients with advanced age ( 9 , 10 ), myocardial infarction (MI) ( 11 ), heart failure (HF) ( 12 ), valvular heart disease ( 13 ), atrial fibrillation ( 14 ), or chronic kidney disease (CKD) ( 15 ). So far, few studies have added nutritional status to the GRACE score for risk stratification assessment, and little is known about whether the predictive value of NRI differs among different subgroups of ACS patients.…”

Section: Introductionmentioning

confidence: 99%

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Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Shao

et al. 2021

Front. Cardiovasc. Med.

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Background: Malnutrition has been shown to be associated with adverse cardiovascular outcomes in many patient populations.Aims: To investigate the prognostic significance of malnutrition as defined by nutritional risk index (NRI) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and whether NRI could improve the GRACE score based prognostic models.Methods: This study applied NRI among 1,718 patients with ACS undergoing PCI. Patients were divided into three nutritional risk groups according to their baseline NRI: no nutritional risk (NRI ≥ 100), mild nutritional risk (97.5 ≤ NRI <100), and moderate-to-severe nutritional risk (NRI <97.5). The primary endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization.Results: During a median follow-up of 927 days, 354 patients developed MACE. In the overall population, compared with normal nutritional status, malnutrition was associated with increased risk for MACE [adjusted HR for mild and moderate-to-severe nutritional risk, respectively: 1.368 (95%CI 1.004–1.871) and 1.473 (95%CI 1.064–2.041)], and NRI significantly improved the predictive ability of the GRACE score for MACE (cNRI: 0.070, P = 0.010; IDI: 0.005, P < 0.001). In the diabetes subgroup, malnutrition was associated with nearly 2-fold high adjusted risk of MACE, and the GRACE score combined with NRI appeared to have better predictive ability than that in the overall population.Conclusion: Malnutrition as defined by NRI was independently associated with MACE in ACS patients who underwent PCI, especially in individuals with diabetes, and improved the predictive ability of the GRACE score based prognostic models.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Shao

et al. 2021

Front. Cardiovasc. Med.

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“…Several objective nutritional tools have recently been used for evaluating malnutrition risk, including the controlling nutritional status (CONUT) score, 16 prognostic nutritional index (PNI), 17 and geriatric nutritional risk index (GNRI). 18 These objective malnutrition scores have been used in patients with heart failure, 19 atrial fibrillation, 20 acute coronary syndrome, 21 and cancers and surgery. 22 Recent studies have assessed malnutrition risk using the objective scores in patients with stroke and reported that malnutrition risk at admission was associated with poor short-term outcomes.…”

mentioning

confidence: 99%

Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Acute Ischemic Stroke: Results From the Third China National Stroke Registry

Zhang

Pan

Zhang

et al. 2022

Stroke

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Background and Purpose: To investigate the prevalence of malnutrition risk in patients with acute ischemic stroke (AIS) at admission, the association between malnutrition risk and long-term outcomes, and whether the predictive ability would be improved after adding to previous prognostic models for poor outcomes. Methods: Based on the Third China National Stroke Registry data from August 2015 to March 2018, we evaluated malnutrition risk using objective scores, including the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index. The primary outcome was death or major disability (modified Rankin Scale score ≥3) at 1 year after stroke onset. We calculated the crude prevalence of malnutrition risk and investigated the association between malnutrition risk and clinical outcomes. Prognostic performance of 3 objective malnutrition scores for poor outcomes was assessed. Results: Moderate to severe malnutrition risk was identified in 5.89%, 5.30%, and 1.95% of the Third China National Stroke Registry AIS patients according to the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index, respectively. At 1-year follow-up, 1143 participants (13.5%) experienced death or major disability. After adjustment for traditional risk factors, moderate to severe malnutrition risk was associated with high risk of composite events (odds ratio, 2.25 [95% CI, 1.75–2.90], for controlling nutritional status score; odds ratio, 2.10 [95% CI, 1.63–2.69], for geriatric nutritional risk index; odds ratio, 3.36 [95% CI, 2.33–4.84], for prognostic nutritional index; all P <0.01). Addition of the 3 malnutrition scores to different predicted scales (iScore and Acute Stroke Registry and Analysis of Lausanne) improved predictive ability for long-term poor outcomes validated by the integrated discrimination index (all P <0.05). Conclusions: The prevalence of moderate or severe malnutrition risk in Chinese patients with AIS ranged from 1.95% to 5.89%. Malnutrition risk in patients with AIS was associated with increased risk of long-term death and major disability. Our study provides evidence supporting the prognostic significance of objective malnutrition scores after AIS.

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“…Malnutrition is commonly prevalent in patients with several CVDs [ 1 , 13 , 14 ]. So far, however, not many studies have evaluated the relationship between nutritional indices, malnutrition, and arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording

et al. 2022

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Background: Malnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition Aim: To evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score and arrhythmic events on 24 hour electrocardiography (ECG) holter recording in patients without manifested arrhythmia. Methods: This study is retrospective analysis of 477 patients who underwent 24 hour ECG holter monitoring. PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1-2: mild risk of malnutrition, ≥3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups. Results: Total number of premature atrial contractions (PACs), premature ventricular contractions (PVCs), PVC burden and incidence of paroxysmal atrial fibrillation (PAF) were higher in patients within the lowest PNI tertile (p < 0.001, p < 0.001, p < 0.001, p = 0.006, respectively). Total number of PVCs, PVC burden and incidence of PAF were higher in patients with CONUT score ≥3 (p < 0.001, p < 0.001, p < 0.001, respectively). Multivariate analysis showed that PNI was independent predictor of presence of PVC (OR=0.935, 95% CI:0.889-0.982, p = 0.008) and PAF (OR=0.911, 95% CI:0.853-0.972, p = 0.005). Also, CONUT score was independent predictor of presence of PVC (OR=1.181, 95% CI:1.013-1.376, p = 0.034) and PAF (OR=1.211, 95% CI:1.017-1.441, p = 0.032). Incidence of non-sustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups. Conclusion: Poor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24 hour ECG holter recording in patients without manifested arrhythmia.

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Malnutrition status in patients of very advanced age with nonvalvular atrial fibrillation and its impact on clinical outcomes

Cited by 16 publications

References 34 publications

Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Acute Ischemic Stroke: Results From the Third China National Stroke Registry

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording

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