Value of prognostic nutritional index for survival prediction in trans-catheter aortic valve replacement compared to other common nutritional indexes

Mas-Peiró, Silvia; Hoffmann, Jedrzej; Seppelt, Philipp; Rosa, Roberta De; Murray, Marie‐Isabel; Walther, Thomas; Zeiher, Andreas M.; Fichtlscherer, Stephan; Vasa‐Nicotera, Mariuca

doi:10.1080/00015385.2020.1757854

Cited by 9 publications

(15 citation statements)

References 29 publications

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“…Several other nutritional indices, such as the Mini‐Nutritional Assessment‐Short Form (MNA‐SF), the Controlling Nutritional Status (CONUT), the Prognostic Nutritional Index (PNI) and the original Nutritional Risk Index (NRI), have also been shown to predict outcomes in TAVR patients in a limited number of studies 5,10,13,14 . Of these, the MNA‐SF involves self‐reporting of nutritional status by patients, whereas the PNI and CONUT, like the GNRI (and NRI), are objective indices based on easily measurable parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, the MNA‐SF involves self‐reporting of nutritional status by patients, whereas the PNI and CONUT, like the GNRI (and NRI), are objective indices based on easily measurable parameters. Whereas the GNRI assesses serum albumin and weight loss, 17 the PNI assesses serum albumin and lymphocyte count, 10 and the CONUT assesses serum albumin, lymphocyte count and total cholesterol 13 . Two small studies have compared the value of the GNRI, PNI and CONUT for predicting 1‐year mortality in TAVR patients, with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…As a hallmark of frailty, malnutrition is common among elderly patients 1–5 and is a predictor of poor outcomes in patients with severe aortic stenosis (AS) 5–9 . Various methods have been used to evaluate the nutritional status of patients undergoing transcatheter aortic valve replacement (TAVR), although no single tool is considered standard in the routine clinical practice setting 5,10–15 …”

Section: Introductionmentioning

confidence: 99%

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Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Seoudy

Al‐Kassou

Shamekhi

et al. 2021

J cachexia sarcopenia muscle

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Background Malnutrition is a hallmark of frailty, is common among elderly patients, and is a predictor of poor outcomes in patients with severe symptomatic aortic stenosis (AS). The Geriatric Nutritional Risk Index (GNRI) is a simple and well‐established screening tool to predict the risk of morbidity and mortality in elderly patients. In this study, we evaluated whether GNRI may be used in the risk stratification and management of patients undergoing transcatheter aortic valve replacement (TAVR). Methods Patients with symptomatic severe AS (n = 953) who underwent transfemoral TAVR at the University Hospital Schleswig‐Holstein Kiel, Germany, between 2010 and 2019 (development cohort) were divided into two groups: normal GNRI ≥ 98 (no nutrition‐related risk; n = 618) versus low GNRI < 98 (at nutrition‐related risk; n = 335). The results were validated in an independent (validation) cohort from another high‐volume TAVR centre (n = 977). Results The low‐GNRI group had a higher proportion of female patients (59.1% vs. 52.1%), higher median age (82.9 vs. 81.8 years), prevalence of atrial fibrillation (50.4% vs. 40.0%), median logistic EuroSCORE (17.5% vs. 15.0%) and impaired left ventricular function (<35%: 10.7% vs. 6.8%), lower median estimated glomerular filtration rate (50 vs. 57 mL/min/1.73 m2) and median albumin level (3.5 vs. 4.0 g/dL) compared with the normal‐GNRI group. Among peri‐procedural complications, Acute Kidney Injury Network (AKIN) Stage 3 was more common in the low‐GNRI group (3.6% vs. 0.6%, p = 0.002). After a mean follow‐up of 21.1 months, all‐cause mortality was significantly increased in the low‐GNRI group compared with the normal‐GNRI group (p < 0.001). This was confirmed in the validation cohort (p < 0.001). Low GNRI < 98 was identified as an independent risk factor for all‐cause mortality (hazard ratio 1.44, 95% CI 1.01–2.04, p = 0.043). Other independent risk factors included albumin level < median of 4.0 g/dL, high‐sensitive troponin T in the highest quartile (> 45.0 pg/mL), N‐terminal pro‐B‐type natriuretic peptide in the highest quartile (> 3595 pg/mL), grade III–IV tricuspid regurgitation, pulmonary arterial hypertension, life‐threatening bleeding, AKIN Stage 3 and disabling stroke. Conclusions Low GNRI score was associated with an increased risk of all‐cause mortality in patients undergoing TAVR, implying that this vulnerable group may benefit from improved preventive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Seoudy

Al‐Kassou

Shamekhi

et al. 2021

J cachexia sarcopenia muscle

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“…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.…”

Section: Resultsunclassified

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

Queiroz

Santos²,

Silva³

et al. 2022

RSD

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Introdução: Os avanços tecnológicos e os novos métodos cirúrgicos têm sido insuficientes para diminuir o alto risco de mortalidade e morbidade em pacientes submetidos à cirurgia cardíaca. Sabe-se que a desnutrição pré-operatória está correlacionada com morbidade, mortalidade, internação hospitalar e qualidade de vida após a cirurgia. O índice prognóstico nutricional (IPN) é calculado a partir dos níveis séricos de albumina e contagem de linfócitos periféricos. Estudos demonstraram que um IPN baixo é um fator prognóstico adverso independente de curto e longo prazo. Objetivo: Avaliar se o índice prognóstico nutricional é um bom marcador prognóstico para prever complicações e óbito em pacientes cirúrgicos cardíacos. Metodologia: Foi feito uma revisão sistemática nas bases de dado PubMed, Lilacs e SciELO, com os seguintes descritores: prognostic nutritional index and cardiac and surgery. Foram escolhido os artigos que avaliassem o IPN e complicações, incluindo óbito, em pacientes cirúrgicos cardíacos. Resultado: Foram analisadas e incluídos na revisão sistemática 19 publicações, destes 13 estudos observacionais prospectivos e 6 estudos observacionais retrospectivas. Deste estudos 9 foram comparações com outros índices, 4 sobre IPN e complicações pós-operatórias e 6 sobre IPN e mortalidade, em grande parte os estudos demonstram que o IPN é uma boa ferramenta para apontar mortalidade e complicações pós-operatórias. Conclusão: Os resultados sugerem que é possível o IPN é uma boa ferramenta para apontar risco de morte e complicações no pós-operatório de cirurgias cardíacas, porém um ponto de corte comum para cirurgia ainda não foi estabelecido.

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“…Trans-catheter aortic valve replacement (TAVR) has dramatically improved prognosis in selected patients with severe aortic stenosis, particularly in those not eligible for surgical replacement ( 9 ). Certain prognostic biomarkers (including those reflecting anemia, renal dysfunction, and malnutrition) ( 10 – 13 ) have been shown to be associated to lower survival rates. Nevertheless, available biomarkers are still limited and there is an unmet need for novel powerful predictors of mortality in such patients.…”

Section: Introductionmentioning

confidence: 99%

Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Mas-Peiró

Seppelt

Rosa

et al. 2020

Front. Cardiovasc. Med.

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Background: Both EPO levels and anemia have shown prognostic value in several cardiac disorders. An observational study with a prospective follow-up was performed to investigate their independent prognostic roles in severe aortic stenosis.Methods: An up to 36-month follow-up of consecutive patients with severe aortic stenosis undergoing TAVR in a high-volume center was performed. Patients with eGRF <30 mL/min/1.73 m2 were excluded. EPO levels and/or anemia status and its association with mid-term mortality were assessed.Results: Out of 407, 360 met eligibility criteria. Median age was 83 years, with 71.4% having a NYHA class III/IV. Anemia was present in 51.9%, and iron deficiency in 52.8%. Median (IQR) EPO levels were 14.4 (9.30–24.30) mIU/mL. Median follow-up was 566 days. Anemia was associated with overall mortality (HR 2.40, 95% CI 1.51–3.80, p < 0.001). Higher logEPO levels were associated with mid-term mortality (HR 4.05, 95% CI 2.29–7.16, p < 0.001), even after adjusting for clinically and/or statistically relevant factors (multivariate HR 2.25, 95 CI 1.09–4.66, p = 0.029). Kaplan-Meier analyses showed early diverging curves for anemia vs. non-anemia, whereas curves for patients in various EPO level quartiles started to diverge at about 100 days, with differences consistently increasing during the subsequent entire follow-up period.Conclusions: Differently from anemia, which was a strong predictor for both early and late mortality in severe aortic stenosis after TAVR, independent prognostic value of EPO only emerged after post-TAVR recovery. EPO prognostic value was independent from anemia and mild-to-moderate renal dysfunction. High EPO levels could be useful to identify patients with severe aortic stenosis showing a compromised mid-term survival in spite of TAVR use and independently from early TAVR results.

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Value of prognostic nutritional index for survival prediction in trans-catheter aortic valve replacement compared to other common nutritional indexes

Cited by 9 publications

References 29 publications

Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

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

Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

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