Impact of Malnutrition Using Geriatric Nutritional Risk Index in Heart Failure With Preserved Ejection Fraction

Abstract Background Malnutrition is associated with adverse prognosis in heart failure patients. However, in patients with heart failure with preserved ejection fraction (HFpEF), the effects of change in nutritional status during hospitalization on prognosis is unknown. Geriatric nutritional risk index (GNRI) is a widely used objective index for evaluating nutritional status. Low GNRI (<92) has moderate or severe nutritional risk and high GNRI (≥92) has no or low nutritional risk. Purpose The purpose of this study was to clarify the effect of change in GNRI during hospitalization on one-year mortality and the association between the value of GNRI and one-year mortality in patients with HFpEF. Methods We prospectively registered patients with HFpEF in PURSUIT-HFpEF registry when they were hospitalized for heart failure in 29 hospitals. Preserved ejection fraction was defined as more than 50% of left ventricular ejection fraction. Of the 486 patients who registered PURSUIT-HFpEF, 228 cases with one-year follow-up data were examined. GNRI was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index/22. Results Mean age was 81±10 years and 100 patients (44%) were male. During a median [interquartile range] follow-up period of 374 [342, 400] days, 28 patients (12%) died. Mortality was significantly higher in patients with low GNRI at admission (n=65) than those with high GNRI at admission (n=163) (26% vs. 9%, log-rank P=0.011) and higher in patients with low GNRI at discharge (n=109) than those with high GNRI at discharge (n=119) (22% vs. 6%, log-rank P=0.002). Multivariate analysis with Cox proportional hazard model with patient characteristics at admission revealed that low GNRI at admission was independently associated with mortality (hazard ratio: 0.96, 95% CI: 0.93–0.99, P=0.035) and that with patient characteristics at discharge revealed that low GNRI at discharge was independently associated with mortality (hazard ratio: 0.94, 95% CI: 0.91–0.97, P<0.001). We also compared mortality by dividing patients into 4 group according to whether GNRI was high or low at the time of admission and discharge. Patients with low GNRI at admission and at discharge (n=59) exhibited the highest mortality, on the other hand, patients with high GNRI at admission and low GNRI at discharge (n=50) exhibited higher mortality than those with high GNRI both at admission and at discharge (n=113) (Low and low: 28% vs. High and low: 14% vs. High and high: 6% vs. Low and high: 0%, log-rank P=0.010). All cause mortality Conclusion GNRI at admission or at discharge was independently associated with one-year mortality in patients with HFpEF. Moreover, worsening GNRI during hospitalization is associated with the worse prognosis. It is important to prevent lowering GNRI during treatment of acute decompensated HFpEF. Acknowledgement/Funding Roche Diagnostics, FUJIFILM Toyama Chemical

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Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

Journal of Clinical Medicine ◽

10.3390/jcm9041169 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1169 ◽

Cited By ~ 5

Author(s):

Susumu Hirose ◽

Sakiko Miyazaki ◽

Shoichiro Yatsu ◽

Akihiro Sato ◽

Sayaki Ishiwata ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Hospital Mortality ◽

Hospital Stay ◽

Risk Index ◽

Length Of Hospital Stay ◽

Interquartile Range ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index

In patients with heart failure (HF), the impact of the Geriatric Nutritional Risk Index (GNRI) on in-hospital mortality and length of hospital stay remains unclear. We aimed to identify the factors associated with increased in-hospital mortality and longer length of hospital stay considering the GNRI in acute decompensated HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Patients with acute decompensated HF who were admitted to our institution between 2007 and 2011 were investigated. A total of 451 (201, HFrEF; 250, HFpEF) patients were divided into the following: patients with GNRI < 92 and ≥92. In HFrEF, there were no significant differences in in-hospital mortality and length of hospital stay between patients with GNRI < 92 and ≥92 (median (interquartile range), 24.0 (23.8) days and 20.0 (15.0) days, respectively, p = 0.32). In HFpEF, despite no differences in in-hospital mortality, patients with GNRI < 92 had significantly longer length of hospital stay than those with GNRI ≥ 92 (median (interquartile range), 20.0 (22.3) days and 17.0 (16.0) days, respectively, p = 0.04). In HFpEF, GNRI < 92, along with lower hemoglobin, higher B-type natriuretic peptide, and elevated C-reactive protein levels, were the independent factors for longer length of hospital stay. Among patients with acute decompensated HF, assessment of nutritional status with GNRI is useful for stratifying patients at high risk for longer length of hospital stay in HFpEF but not in HFrEF. These observations are particularly important when considering the increasing elderly population and prevalence of HFpEF.

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PROGNOSTIC IMPACT OF GERIATRIC NUTRITIONAL RISK INDEX IN ELDERLY PATIENTS WITH HEART FAILURE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32413-1 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1807

Author(s):

Takahiro Okano ◽

Hirohiko Motoki ◽

Masatoshi Minamisawa ◽

Kazuhiro Kimura ◽

Soichiro Ebisawa ◽

...

Keyword(s):

Heart Failure ◽

Elderly Patients ◽

Risk Index ◽

Nutritional Risk ◽

Prognostic Impact ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index ◽

Patients With Heart Failure

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Geriatric Nutritional Risk Index Predicts Cardiovascular Events in Patients at Risk for Heart Failure

Circulation Journal ◽

10.1253/circj.cj-17-0255 ◽

2018 ◽

Vol 82 (6) ◽

pp. 1614-1622 ◽

Cited By ~ 19

Author(s):

Masatoshi Minamisawa ◽

Takashi Miura ◽

Hirohiko Motoki ◽

Yasushi Ueki ◽

Hitoshi Nishimura ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Cardiovascular Events ◽

Risk Index ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index ◽

Patients At Risk

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Abstract 12986: Geriatric Nutritional Risk Index Provides the Additional Long-term Prognostic Information to Gwtg Heart Failure Risk Score in Acute Decompensated Heart Failure Patients With and Without Reduced LVEF

Circulation ◽

10.1161/circ.142.suppl_3.12986 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Tetsuya Watanabe ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Nutritional Status ◽

Risk Score ◽

Risk Index ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Prognostic Information ◽

Poor Outcome ◽

Nutritional Risk Index

Backgrounds: The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and has been recently reported to be associated with post-discharge long-term outcomes. Malnutrition is associated with poor outcome in ADHF patients. However, there is no information available on the long-term prognostic significance of the combination of GWTG-HF risk score and malnutrition in patients admitted for ADHF, relating to reduced left ventricular ejection fraction (LVEF). Methods: We studied 303 ADHF patients discharged with survival (HFrEF(LVEF<40%); n=180, HFpEF(LVEF≥40%;n=123). At the admission, we evaluated GWTG-HF score and nutritional status. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 · serum albumin (g/dl) + 41.7 · BMI/22, and malnutrition was defined as GNRI<92. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. Results: During a follow-up period of 4.2±3.3 yrs, 86 patients had CVR. At multivariate Cox analysis, GWTG-HF risk score and GNRI were significantly and independently associated with CVR, in both HFrEF and HFpEF groups. The patients with both greater GWTG-HF score (>median value=35) and malnutrition had a significantly increased risk of CVR than those with either and none of them ([HFrEF] 60% vs 32% vs 16%, p<0.0001, [HFpEF] 45% vs 18% vs 12%, p<0.0001, respectively) Conclusion: Malnutrition assessed by GNRI would provide the additional long-term prognostic information to GWTG-HF risk score in patients admitted for ADHF, irrespective of the presence of reduced LV function.

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