Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition‐SAVR trial)

Abstract

Aim Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in‐hospital and long‐term mortality in patients undergoing surgical aortic valve replacement (SAVR). Methods PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66–74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes. Results During the 50 ± 31 months follow‐up period, a total of 36 (24%) patients died. 30‐day mortality, 1‐year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0–2] vs. 2 [0.2–3]; p < .001) was significantly higher. Conclusion Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.

Low-Density Lipoprotein Cholesterol and Mortality Risk in Elderly Patients Undergoing Valve Replacement Surgery: A Propensity Score Matching Analysis

“…The PNI is a frequently used index in clinical practice to assess one's nutritional status and has been proven to be positively correlated with prognosis in multiple situations, such as surgical high-risk and elderly patients ( 29 ). As for VRS, a similar correlation was verified by Cho et al ( 30 ) and Gürbak et al ( 31 ). Thus, the significant relationship between LDL-C and mortality before matching in our study may be the result of the confounding effect of PNI.…”

Índice prognóstico nutricional como marcador em pacientes cirúrgicos cardíacos: uma revisão sistemática

“…A busca na literatura identificou 426 registros no total, dos quais 22 foram avaliados com mais detalhes e 19 publicações, sendo 13 de estudos observacionais prospectivos (Bayram et al, 2022;Cai et al, 2022;Cho et al, 2021;Felpel et al, 2021;Gürbak et al, 2021;Kurumisawa & Kawahito, 2018;Lee et al, 2020;Lin et al, 2021;Öcal et al, 2020;Okuno et al, 2019;Tasbulak et al, 2021;Yost et al, 2018) e 6 estudos observacionais prospectivos (Açıkel & Korkut, 2019;Kucukosmanoglu et al, 2021;Mas-Peiro et al, 2021;Panç et al, 2020;Tóth et al, 2022), foram incluídos na revisão sistemática, podendo ser visualizados na Tabela 1, que traz as informações de autoria, tipo e período do estudo, além do número de participantes e de casos, e objetivo e resultados encontrados nos artigos inclusos na presente revisão. Quanto ao local de realização das pesquisas, 9 dos estudos foram da Europa, dois dos EUA e 5 da Ásia e a duração do seguimento variou de 1 a 10 anos.…”

“…Quanto ao local de realização das pesquisas, 9 dos estudos foram da Europa, dois dos EUA e 5 da Ásia e a duração do seguimento variou de 1 a 10 anos. 6 estudos faziam comparação com outros índices (Açıkel & Korkut, 2019;Cho et al, 2021;Felpel et al, 2021;Gürbak et al, 2021;Kucukosmanoglu et al, 2021;Tasbulak et al, 2021) Lee et al, 2020;Öcal et al, 2020;Yost et al, 2018), e 6 avaliaram a influência do IPN na mortalidade pós-cirúrgica (Cai et al, 2022;Kurumisawa & Kawahito, 2018;Lin et al, 2021;Mas-Peiro et al, 2021;Panç et al, 2020) (Figura 2).…”

“…Esta revisão sistemática, utilizou estudos observacionais prospectivos e retrospectivos de IPN e prognóstico de pacientes cirúrgicos cardíacos, esclareceu que o IPN pode predizer os resultados pós-cirúrgicos (Lee et al, 2020). Além disso, um baixo IPN está relacionado ao surgimento de mais complicações no pós-operatório (PO) (Açıkel & Korkut, 2019;Panç et al, 2020), a redução na sobrevida (Bayram et al, 2022;Öcal et al, 2020;Tasbulak et al, 2021;Yost et al, 2018), uma taxa de mortalidade significativamente maior nos período de 30 dias e 1 ano pós cirurgia (Cai et al, 2022;Cho et al, 2021;Gürbak et al, 2021;Kucukosmanoglu et al, 2021;Lin et al, 2021;Mas-Peiro et al, 2021;Okuno et al, 2019;Panç et al, 2020;Tóth et al, 2022), e é um forte preditor de morte a longo prazo (Cai et al, 2022;Kurumisawa & Kawahito, 2018). Research, Society and Development, v. 11, n. 9, e50611932106, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i9.32106 relacionado a um maior tempo de internamento PO, além de maiores taxa de insuficiência ventricular direita, além disso estaria associado a um percentual de 12,2% de redução na sobrevida PO.…”

Association Between Nutritional Indices and Long-Term Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting

“…Gürbak et al previously researched the outcome of all three tools on patients who underwent aortic valve replacement. Their study demonstrated the association between PNI, GNRI, CONUT score, and outcome after aortic valve replacement [ 21 ]. Similar to their study, we have also demonstrated the association of nutritional status with three different tools and cardiovascular events after isolated CABG surgery.…”