Prognostic importance of the Controlling Nutritional Status (CONUT) score in patients undergoing cardiac resynchronisation therapy

Abstract

AimsMalnutrition is common and associated with worse clinical outcomes in patients with heart failure (HF). The Controlling Nutritional Status (CONUT) score is an integrated index for evaluating diverse aspects of the complex mechanism of malnutrition. However, the relationship between the severity of malnutrition assessed by the CONUT score and clinical outcomes of HF patients receiving cardiac resynchronisation therapy (CRT) has not been fully clarified.MethodsClinical records of 263 patients who underwent pacemaker or defibrillator implantation for CRT between March 2003 and October 2020 were retrospectively evaluated. The CONUT score was calculated from laboratory data obtained before CRT device implantation. Patients were divided into three groups: normal nutrition (CONUT scores 0–1, n=58), mild malnutrition (CONUT scores 2–4, n=132) and moderate or severe malnutrition (CONUT scores 5–12, n=73). The primary endpoint was all-cause mortality.ResultsThe moderate or severe malnutrition group had a lower body mass index, more advanced New York Heart Association functional class, higher Clinical Frailty Scale score, lower levels of haemoglobin and higher levels of N-terminal probrain natriuretic peptide (all p<0.05). In the moderate or severe malnutrition group, the CRT response rate was significantly lower than for the other two groups (p=0.001). During a median follow-up period of 31 (10–67) months, 103 (39.1%) patients died. Kaplan-Meier analysis revealed that the moderate or severe malnutrition group had a significantly higher mortality rate (log-rank p<0.001). A higher CONUT score and CONUT score ≥5 remained significantly associated with all-cause mortality after adjusting for previously reported clinically relevant factors and the conventional risk score (VALID-CRT risk score) (all p<0.05).ConclusionsA higher CONUT score before CRT device implantation was strongly associated with HF severity, frailty, lower CRT response rate and subsequent long-term all-cause mortality.

Nutritional Status Predicts the Length of Stay and Mortality in Patients Undergoing Electrotherapy Procedures

“…Our study was focused on the early complications and mortality of patients undergoing CIED implantations and did not include a long-term analysis. However, it is worth noting that the available literature shows a significantly lower response rate for CRT in the moderate or severe malnutrition groups [ 37 ]. That study included 263 patients.…”

“…Regarding non-fatal, clinical outcomes of CIED implantations, the study by Balli et al revealed that poorer immunonutritional status was also associated with the development of pacing-induced cardiomyopathy [ 36 ]. Better nutritional status was also related to better responses to CRT in a study by Ikeya et al [ 37 ]. However, there have not been any papers published focused on the length of hospital stay after CIED implantation in the context of nutritional status.…”

The clinical value of the Controlling Nutritional Status score for predicting prognosis in systolic heart failure cases in the vulnerable phase

“…At present, compared with drop an age, BNP and AST, nutritional status in HF cases has not been paid enough attention in clinical practice, but its predictive value for all-cause mortality of systolic HF within 90 days after discharge of heart failure cannot be ignored. It was found an elevated baseline CONUT score is associated with HF severity, and significantly improved predictive value is obtained with the CONUT score added to conventional risk scores for predicting 1-year all-cause death in HF cases administered cardiac therapy in synchrony ( 26 ). Therefore, combining the traditional risk factors with the CONUT score may provide further information in clinical risk assessment, to improve the prediction of adverse outcomes in the vulnerable phase of systolic HF.…”

Prognostic Value of Cheyne-Stokes Respiration and Nutritional Status in Acute Decompensated Heart Failure

“…Likewise, in our study, patients with ADHF and malnutrition also had high all-cause mortality during the long-term follow-up. Several studies have shown an association between a single nutritional indicator, including BMI, total cholesterol, serum albumin and total lymphocyte count, and poor outcomes in patients with HF [ 28 , 29 ]. However, the assessment of only one indicator of malnutrition may not provide adequate prognostic information.…”

“…A higher CONUT score implies malnutrition and impaired inflammatory response, supporting the notion that catabolic wasting and the immune system play an essential role in the development of ADHF. Previous Japanese population-based studies have shown that the median BMI was 22 kg/m 2 in patients with HF [ 8 , 28 ]. In the present study population, the median BMI was >24 kg/m 2 with and without malnutrition.…”