Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients

Abstract

Introduction Hospitalized advanced heart failure (HF) patients are at high risk for malnutrition and death. The Nutritional Risk Index (NRI) is a simple, well-validated tool for identifying patients at risk for nutrition-related complications. We hypothesized that in advanced HF patients from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, the NRI would improve risk discrimination for 6-month all-cause mortality. Methods We analyzed the 160 ESCAPE index admission survivors with complete follow-up and NRI data, calculated as follows: NRI = (1.519 × discharge serum albumin, g/dL) + {41.7 × discharge weight (kg)/ideal body weight (IBW; kg)}; as in previous studies, if discharge weight > IBW, this ratio was set = 1. The previously developed ESCAPE mortality model includes age, 6-minute walk distance, CPR/mechanical ventilation, discharge beta-blocker prescription and diuretic dose, and discharge serum sodium, blood urea nitrogen, and B-type natriuretic peptide levels. We used Cox proportional hazards modeling for the outcome of 6-month all-cause mortality. Results 30/160 patients died within 6 months of hospital discharge. The median NRI was 96 (IQR 91-102), reflecting mild-to-moderate nutritional risk. The NRI independently predicted 6-month mortality, with adjusted HR 0.60 (95% CI 0.39-0.93), p=.02) per 10 units, and increased Harrell's c index from 0.74 to 0.76 when added to the ESCAPE model. Body mass index and NRI at hospital admission did not predict 6-month mortality. The discharge NRI was most helpful in patients with high (≥ 20%) predicted mortality by the ESCAPE model, where observed 6-month mortality was 38% in patients with NRI < 100 and 14% in those with NRI >100 (p=0.04). Conclusions The NRI is a simple tool that can improve mortality risk stratification at hospital discharge in hospitalized patients with advanced HF.

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

“…These findings are consistent with the result from the KAMIR‐based study mentioned above and other Asian studies that have used hypoalbuminemia, waist‐to‐hip ratio, body mass index, or other computed measures of nutrition as a surrogate for malnutrition among patients with ST‐elevated AMI undergoing PCI. Our results also concur with studies of PEM in other conditions such as heart failure, acute ischemic stroke, sepsis, hip fractures, and PEM among patients hospitalized in a general medical and surgical floor . We reason that subjects with PEM have generally lower cardiac and systemic muscle and nutrient reserve and may sustain more significant damage from the myocardial ischemic event .…”

“…Similar to the heart, the kidney, brain, and lungs are also malnourished and may likely sustain greater damage from the AMI. These are all consistent with the impact of PEM in other diseases …”

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

“…Our results showed that all-cause death occurred more frequently in HFpEF patients with moderate or major nutrition-related risk than in those with low or no nutrition-related risk ( Table 3 and Model 4). [7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, to our knowledge, all but one 18 of the previous studies reported on so-called HF patients, and therefore, our specific findings for 'HFpEF patients' are novel. The results of the present study indicate that screening nutritional status using a GNRI at discharge further refines risk assessment in patients hospitalized with HFpEF.…”

Micronutrient Deficiency Independently Predicts Time to Event in Patients With Heart Failure

“…This finding is comparable to that of Shetty et al,53 who reported that the number of dietary micronutrient deficiencies was similar in normal weight and overweight/obese patients with heart failure. Many screening tools for malnutrition (eg Geriatric Nutritional Risk Index, Mini Nutrition Assessment, Nutritional Risk Index) include an anthropometric measure, most commonly BMI 54, 55. Although such indexes predict outcomes in patients with heart failure, they may have lower sensitivity for identifying malnutrition risk in patients with high BMI.…”