scholarly journals Association of Herpesvirus Response Burden with Long-Term Mortality Differs Between Older Males and Females

2020 ◽  
Author(s):  
Timo E Strandberg ◽  
Mikko Seppänen ◽  
Kaisu H Pitkälä ◽  
Mika Kivimäki ◽  
Pentti J Tienari
Keyword(s):  
Immune Responses ◽  
Cox Regression ◽  
Total Mortality ◽  
List Type ◽  
Baseline Serum ◽  
Bacterial Response ◽  
Older Males ◽  
Response Burden ◽  
Long Term Mortality

AbstractBackgroundSex-specific immune responses may contribute to variable vulnerability for Covid-19 between females and males. We tested whether there is a long-term mortality difference between sexes for other microbes (viral and bacterial) response burden among older people.MethodsSeven-year follow-up study consisted of 382 home-dwelling people aged 75-90 years (65.2% females) with a history cardiovascular disease. At baseline, serum immunoglobulin G antibodies were assayed against herpesviruses (CMV, HSV-1 and HSV-2) and bacteria (Chlamydophila pneumoniae, Mycoplasma pneumonia, and Helicobacter pylori). Titers were summed up as herpes (HB) or bacterial response burden (BB) and divided into tertiles. Hazard ratios (HR) of total mortality with 95% CIs were calculated using Cox regression.ResultsThe overall HB was lower and BB higher among males than females (P<0.001). There was a significant sex/HB (P=0.01) and sex/BB (P=0.03) interaction with mortality. Multivariable-adjusted (age, body mass index, C-reactive protein, and comorbidity index) mortality HRs for increasing HB sex-specific tertiles were 1.0 (reference), 1.34 (95% CI 0.62-2.88), and 2.66 (1.25-5.64) for males and 1.0, 1.30 (0.76-2.21), and 1.30 (0.77-2.22) for females. The significant age-adjusted association between BB and mortality in males attenuated after multivariable adjustments, HR (top-vs-bottom tertile) 1.74 (0.93-3.25). In females, no association with BB was observed. Using HB and BB as continuous variables supported the findings with tertiles.ConclusionsAlthough being lower in older males than females, higher Herpesviridae response burden was associated with increased 7-year mortality risk among males, not among females. Immune responses to common microbes may contribute to sex differences in longevity and mortality.Key points-Gender differences in vulnerability during Covid-19 has increased interested in sex-related responses to infections-We used IgG titers of Herpesviridae and bacteria as surrogate markers for variably recurrent reactivation-Although Herpesviridae response burden was generally lower among males than females, within sexes higher Herpesviridae burden strongly predicted 7-year mortality among males but not females-Long-term virus burden, like Herpesviridae, may partly explain shorter longevity and higher mortality among males with weaker immune systems

scholarly journals Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Johanna Helmersson-Karlqvist ◽  
Miklos Lipcsey ◽  
Johan Ärnlöv ◽  
Max Bell ◽  
Bo Ravn ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Risk Prediction ◽  
Cystatin C ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Sample Tube ◽  
Long Term Mortality

AbstractDecreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Angiology ◽  
2021 ◽  
pp. 000331972098795
Author(s):  
Songyuan Luo ◽  
Yi Zhu ◽  
Enmin Xie ◽  
Huanyu Ding ◽  
Fan Yang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Landing Zone ◽  
End Point ◽  
Male Patients ◽  
Long Term Mortality

We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

scholarly journals Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kawai ◽  
D Nakatani ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Plasma Volume ◽  
Cox Regression ◽  
Volume Status ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

scholarly journals Long-term mortality in young patients with spontaneous intracerebral haemorrhage: Predictors and causes of death

2021 ◽  
Vol 6 (2) ◽  
pp. 185-193
Author(s):  
Jamie I Verhoeven ◽  
Marco Pasi ◽  
Barbara Casolla ◽  
Hilde Hénon ◽  
Frank-Erik de Leeuw ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Intracerebral Haemorrhage ◽  
Causes Of Death ◽  
Cox Regression ◽  
Young Patients ◽  
University Hospital ◽  
Standardized Mortality Ratio ◽  
Excessive Alcohol Consumption ◽  
Long Term Mortality

Introduction Intracerebral haemorrhage (ICH) in young adults is rare but has devastating consequences. We investigated long-term mortality rates, causes of death and predictors of long-term mortality in young spontaneous ICH survivors. Patients and methods We included consecutive patients aged 18–55 years from the Prognosis of Intracerebral Haemorrhage cohort (PITCH), a prospective observational cohort of patients admitted to Lille University Hospital (2004–2009), who survived at least 30 days after spontaneous ICH. We studied long-term mortality with Kaplan-Meier analyses, collected causes of death, performed uni-/multivariable Cox-regression analyses for the association of baseline characteristics with long-term mortality. Results Of 560 patients enrolled in the PITCH, 75 patients (75% men) met our inclusion criteria (median age 50 years, interquartile range [IQR] 44–53 years). During a median follow-up of 8.2 years (IQR 5.0–10.1), 26 patients died (35%), with a standardized mortality ratio of 13.0 (95% confidence interval [95% CI] 8.5–18.0) compared to peers from the general population. Causes of death were vascular in 7 (27%) patients, non-vascular in 13 (50%) and unknown in 6 (23%). Global cerebral atrophy (hazard ratio [HR] 3.0, 95% CI 1.1–8.6), modified Rankin Score >2 before ICH (HR 3.4, 95% CI 1.0–11.0), and excessive alcohol consumption (HR 3.3, 95% CI 1.1–10.2) were independently associated with long-term mortality. Discussion We found a 13-fold higher mortality risk for young ICH survivors compared to the general French population. Predictors of long-term mortality were pre-existing conditions, not ICH-characteristics. Conclusion Young ICH survivors remain at increased mortality risk of vascular and non-vascular death for years after ICH.

scholarly journals Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199299
Author(s):  
Wenlan Hu ◽  
Kaiping Zhao ◽  
Youzhou Chen ◽  
Jihong Wang ◽  
Mei Zheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Orthopaedic Surgery ◽  
Troponin I ◽  
Cox Regression ◽  
St Elevation Myocardial Infarction ◽  
Entire Cohort ◽  
St Elevation ◽  
Universal Definition ◽  
Long Term Mortality

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.

Abstract P290: Short-term Weight Change and Long-term Mortality in the Trials of Hypertension Prevention

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Nancy R Cook ◽  
Lawrence J Appel ◽  
Paul K Whelton
Keyword(s):  
Weight Loss ◽  
Weight Change ◽  
Phase 1 ◽  
Total Mortality ◽  
Weight Loss Intervention ◽  
Phase 2 ◽  
Short Term ◽  
Hypertension Prevention ◽  
Long Term Mortality

Introduction: Although weight loss has favorable effects on intermediate outcomes, such as blood pressure and insulin resistance, few studies have examined its effects on long-term outcomes including total mortality. Methods: In the Trials of Hypertension Prevention (TOHP) individuals aged 30-54 years with high normal BP were randomized to a weight loss intervention, to one of several other lifestyle or dietary supplement interventions, or to usual care. All participants from Phase 1 (1987-90) and Phase 2 (1990-5) were followed for mortality through 2013. The association of weight change during any of the interventions with long-term mortality up to 18-24 years after the trial periods was examined among 3828 participants who fell into a high baseline weight stratum, defined as body mass index at least 26 kg/m2 in men and 24 kg/m2 in women. Results and Conclusions: There were 1477 high-weight participants in Phase 1 and 2351 in Phase 2, of whom 21% and 50%, respectively, were assigned to a weight loss intervention. Overall, mean weight change during the trial period was -1.8 lbs (-0.8% of baseline body weight) over 1.5 years in Phase 1 and 1.6 lbs (0.8%) over 3-4 years in Phase 2. A total of 556 (15%) lost > 5%, 1,101 (29%) lost <=5%, 1,567 (41%) gained less than 5%, and 604 (16%) gained > 5% in body weight. Corresponding hazard ratios (HRs) for total mortality were 0.82 (95% confidence interval (CI)=0.57-1.18), 0.94 (95% CI=0.72-1.23), 1.00 (reference), and 1.29 (95% CI=0.92-1.80) (p-trend = 0.046). There was a direct linear relationship with percent change in weight during the trial period and later mortality (HR=1.14 per 5% change, 95% CI=1.02-1.28, p=0.019). This association persisted throughout the course of mortality follow-up (Figure). In these healthy individuals taking part in lifestyle and nutrition supplement trials , short-term weight change was directly associated with mortality about two decades later. These results are consistent with a long-term beneficial effect of presumed intentional weight loss on total mortality.

scholarly journals Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Zhang ◽  
X Xie ◽  
C He ◽  
X Lin ◽  
M Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Remodeling ◽  
Cox Regression ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Abstract Background Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI). Purpose To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI. Methods We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a &gt;15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) &lt;50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis. Results The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P&lt;0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P&lt;0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002). Conclusions LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality. FUNDunding Acknowledgement Type of funding sources: None. Association Between LLVR and outcomes Kaplan-Meier Estimates of the Mortality

scholarly journals Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study

2019 ◽  
Vol 68 (2) ◽  
pp. 392-396 ◽  
Author(s):  
Akito Tsukinaga ◽  
Shunsuke Takaki ◽  
Takahiro Mihara ◽  
Kenta Okamura ◽  
Susumu Isoda ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Cardiovascular Surgery ◽  
Cox Regression ◽  
Prolonged Mechanical Ventilation ◽  
Cox Regression Analysis ◽  
Icu Admission ◽  
Risk Patients ◽  
Long Term Mortality

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study aimed to evaluate the effects of perioperative hematocrit levels on mortality in patients requiring prolonged mechanical ventilation (PMV) after a cardiovascular surgery. This single-center retrospective cohort study was conducted on 172 patients who underwent cardiovascular surgery with cardiopulmonary bypass or off-pump coronary artery bypass grafting and required PMV for ≥72 hours in the intensive care unit (ICU) from 2008 to 2012 at the Yokohama City University Medical Center in Yokohama, Japan. Patients were classified according to hematocrit levels on ICU admission: high (≥30%) and low (<30%) groups. Of 172 patients, 86 were included to each of the low-hematocrit and high-hematocrit groups, with median hematocrit levels (first to third quartiles) of 27.4% (25.4%–28.7%) and 33.0% (31.3%–35.5%), respectively. The difference in survival rates was significant between the two groups using the log-rank test (HR 0.55, 95% CI 0.32 to 0.95, p=0.033). Cox regression analysis revealed that ≥30% increase in hematocrit levels on ICU admission was significantly associated with decreased long-term mortality (HR 0.40, 95% CI 0.20 to 0.80, p=0.0095). Lower hematocrit levels on ICU admission was a risk factor for increased long-term mortality, and higher hematocrit levels might outweigh the risk of transfusion in patients requiring PMV after a cardiovascular surgery.

Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI

Angiology ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Adnan Kaya ◽  
Muhammed Keskin ◽  
Mustafa Adem Tatlisu ◽  
Osman Kayapinar
Keyword(s):  
Regression Analysis ◽  
Ventricular Arrhythmia ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Ventricular Arrhythmias ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Normal Ranges ◽  
Long Term Mortality

We evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges.

P2619Combined evaluation of nutrition screening indexes on long-term mortality in patients hospitalized for acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Kenichiro ◽  
M Oguri ◽  
K Takahara ◽  
T Sumi ◽  
H Takahashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Regression Model ◽  
Body Mass ◽  
Cox Regression ◽  
Cox Regression Model ◽  
Predictive Values ◽  
Conut Score ◽  
Long Term Mortality

Abstract Background Along with an aging society, the global burden of heart failure (HF) is evident in Japan. Recent reports showed that malnutrition is one of the frequent comorbidity in patients with HF, and this grievous issue is related to worsening prognosis in such subjects. There are many screening tools of nutrition risks, however, feasible indexes or strategies for evaluating nutrition risk in patients with HF remain to be identified definitively. Purpose The purpose of the present study was to examine the effectiveness of various nutrition indexes on 3-year mortality in hospitalized acute HF patients. Methods The study population comprised a total of 817 individuals who were hospitalized for acute HF between November 2009 and December 2015, and was followed up for 3 years. All the previously established objective nutritional indexes [The controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and subjective global assessment (SGA)] were evaluated at the time of hospital admission. Malnutrition status of each index was defined as CONUT score ≥5, GNRI <91, or SGA (B and C), respectively. We evaluated combined predictive values of these indexes for 3-year mortality by Cox regression model, and calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Results The median age was 79 (interquartile range 70–85) years, and 55.7% of the subjects were male. The frequency of malnutrition was 18.1% in CONUT score, 31.9% in GNRI, and 25.9% in SGA. The rate of 3-year mortality was 32.2%. All indexes were related to the occurrence of 3-year mortality by univariate analyses (P<0.001). We examined combined predictive values by calculating multivariable-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for associations of malnutrition by these 3 indexes and prognostic variables identified by multivariable Cox regression model (age, body mass index, systolic blood pressure, reduced eGFR, albumin, and prior HF hospitalization). Malnutrition of all 3 indexes (5.6% of the subjects) was associated with higher relative risk of 3-year mortality than well-nutrition (aHR 1.90; 95% CI 1.07–3.35, P=0.028), or malnutrition of any 1 index (aHR 1.95; 95% CI 1.18–3.21, P=0.009). Next, we individually included each value into a reference model (age, body mass index, reduced eGFR, albumin, prior HF hospitalization, and ischemic etiology by multivariable logistic regression analysis with P<0.05). SGA was superior according to comprehensive discrimination, calibration, and reclassification analysis (NRI 0.212, P=0.003; IDI 0.005, P=0.029). Similar analysis with other indexes (CONUT score or GNRI) revealed no improvement. Conclusion Our present results suggest that simultaneous addition of CONUT, GNRI, and SGA seems useful for predicting long-term mortality in acute HF. In addition, nutritional screening with SGA independently improves mortality risk stratification.

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