Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Abstract

Background: The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients.Methods: Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality.Results: The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). Conclusions:The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.

Preoperative Phase Angle as a Risk Indicator in Cardiac Surgery—A Prospective Observational Study

“…Serum albumin can also be used as a malnutrition marker; low levels are associated with adverse outcomes after cardiac surgery [36]. Although we found lower serum albumin levels in patients with lower preoperative PhA, the preoperative PhA was not influenced by the preoperative serum albumin levels in our cohort.…”

Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

“…Malnutrition has been reportedly associated with a poor prognosis postcardiovascular surgery. 24 In this study hospital, patients with malnutrition received periodical nutrition assessment and dietary guidance from a registered dietitian, and the improved nutritional status may have contributed to the improved prognosis. Furthermore, preoperative cognitive dysfunction is a known poor prognostic factor for vascular surgery.…”

Poor nutritional status and frailty associated with acute kidney injury after cardiac surgery: A retrospective observational study

“…15 A preoperative assessment of both scoring systems in cardiac surgery has reported them to be useful and safe. 12,15 The present study investigates the role of preoperative nutritional status and frailty, which have been shown to affect mortality after cardiac surgery, in AKI, as a complication with a high incidence after cardiac surgery. The primary outcome was the development of AKI within the first postoperative week, defined according to the kidney disease improving global outcomes (KDIGO) criteria in which AKI is classified based on the maximum change in sCr from the preoperative baseline levels.…”

“…Frailty is a multifactorial process, and poor nutritional status is considered to contribute to its pathophysiology. Like frailty, malnutrition is also associated with medium‐ and long‐term mortality after cardiac surgery 12,13 . The most commonly applied nutritional scoring systems in recent studies aimed at assessing nutritional status are the geriatric nutritional risk index (GNRI) 14 and the prognostic nutritional index (PNI) 15 .…”

“…Like frailty, malnutrition is also associated with medium-and longterm mortality after cardiac surgery. 12,13 The most commonly applied nutritional scoring systems in recent studies aimed at assessing nutritional status are the geriatric nutritional risk index (GNRI) 14 and the prognostic nutritional index (PNI). 15 A preoperative assessment of both scoring systems in cardiac surgery has reported them to be useful and safe.…”