Prevalence and prognostic value of malnutrition in patients with acute coronary syndrome and chronic kidney disease

Abstract

BackgroundMalnutrition is a rising global health issue associated with unfavorable outcomes of a variety of disorders. Currently, the prevalence and prognostic significance of malnutrition to patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) remained largely unclear.MethodsA total of 705 patients diagnosed with ACS and CKD in the First Affiliated Hospital of Wenzhou Medical University between 2013 and 2021 were included in this retrospective cohort study. Malnutrition was assessed by the Controlling Nutritional Status (CONUT), the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI), respectively. The relationships between malnutrition and all-cause mortality and major cardiovascular events (MACEs) were analyzed.ResultsDuring a median follow-up of 31 months, 153 (21.7%) patients died, and 165 (23.4%) had MACEs. The prevalence of malnutrition was 29.8, 80.6, and 89.8% for the PNI, CONUT, and GNRI, respectively. All the malnutrition indexes were correlated with each other (r = 0.77 between GNRI and PNI, r = −0.72 between GNRI and CONUT, and r = −0.88 between PNI and CONUT, all p < 0.001). Compared with normal nutrition, malnutrition was independently associated with an increased risk for all-cause mortality (adjusted hazard ratio for moderate and severe degrees of malnutrition, respectively: 7.23 [95% confidence interval (CI): 2.69 to 19.49] and 17.56 [95% CI: 5.61 to 55.09] for the CONUT score, 2.18 [95% CI: 0.93 to 5.13] and 3.16 [95% CI: 1.28 to 7.79] for the GNRI, and 2.52 [95% CI: 1.62 to 3.94] and 3.46 [95% CI: 2.28 to 5.25] for the PNI score. p values were lower than 0.05 for all nutritional indexes, except for moderate GNRI p value = 0.075). As for MACEs, similar results were observed in the CONUT and PNI. All the risk scores could improve the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score for both all-cause mortality and MACEs.ConclusionMalnutrition was common in patients with ACS and CKD regardless of the screening tools used, and was independently associated with all-cause mortality and MACEs. Malnutrition scores could facilitate risk stratification and prognosis assessment.

Role of composite objective nutritional indexes in patients with chronic kidney disease

“…Ni et al discovered that a lower PNI was independently associated with an increased risk of mortality and enhanced the predictive capability of the GRACE score for overall death and MACEs in patients with ACS and CKD. Similar findings were observed with CONUT and PNI ( 89 ). Thus, enhancing the pre-angiography nutritional status of patients with CKD based on the PNI value can reduce the incidence of CA-AKI.…”

“…In recent years, the relevance of the CONUT score in CKD has attracted significant attention. As mentioned above, similar to PNI, the CONUT score enhanced the predictive ability of the GRACE score for overall death and MACEs in patients with ACS and CKD ( 89 ). In addition, the CONUT score exhibited an independent relationship with prior CVD in patients with CKD and demonstrated a superior correlation with disease activity in patients with lupus nephritis compared with other nutritional evaluation indexes ( 84 , 85 ).…”

Combined effect of inflammation and malnutrition for long-term prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study

“…Nutritional status influences the body’s inflammatory response, and consistent nutritional management is crucial for patients with critical illness to recover from inflammatory injury [ 27 , 29 ]. Although the prevalence of malnutrition exhibited significant discrepancies, its association with poorer outcomes remains clear and sound [ 19 – 22 , 30 , 31 ]. However, the importance of screening and monitoring for malnutrition in patients with ACS hasn’t drawn enough concern from clinical guidelines and practice [ 32 , 33 ].…”

Combined Effect of Inflammation and Malnutrition for Long-term Prognosis in Patients with Acute Coronary Syndrome: A Cohort Study

“…In another cohort with 705 patients diagnosed with ACS and chronic kidney disease (CKD), malnutrition was found in 30%, 80%, and 90% of the population according to the PNI, CONUT, and GNRI, respectively 26 . Data from 5,062 ACS patients suggested that malnutrition prevailed in over 50% of cases based on the CONUT score, NRI, or PNI 27 .…”

“…Although the prevalence of malnutrition exhibited significant discrepancies, its association with poorer outcomes remains clear and sound [23][24][25][26][27][28] . However, the importance of screening and monitoring for malnutrition in patients with ACS hasn't drawn enough concern from clinical guidelines and practice 13,14 .…”