scholarly journals Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3311
Author(s):  
Sayaki Ishiwata ◽  
Shoichiro Yatsu ◽  
Takatoshi Kasai ◽  
Akihiro Sato ◽  
Hiroki Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Weight ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Nutritional Index ◽  
All Cause Mortality

The TCB index (triglycerides × total cholesterol × body weight), a novel simply calculated nutritional index based on serum triglycerides (TGs), serum total cholesterol (TC), and body weight (BW), was recently reported to be a useful prognostic indicator in patients with coronary artery disease. Thus, this study aimed to investigate the relationship between TCBI and long-term mortality in acute decompensated heart failure (ADHF) patients. Patients with a diagnosis of ADHF who were consecutively admitted to the cardiac intensive care unit in our institution from 2007 to 2011 were targeted. TCBI was calculated using the formula TG (mg/dL) × TC (mg/dL) × BW (kg)/1000. Patients were divided into two groups according to the median TCBI value. An association between admission TCBI and mortality was assessed using univariable and multivariable Cox proportional hazard analyses. Overall, 417 eligible patients were enrolled, and 94 (22.5%) patients died during a median follow-up period of 2.2 years. The cumulative survival rate with respect to all-cause, cardiovascular, and cancer-related mortalities was worse in patients with low TCBI than in those with high TCBI. In the multivariable analysis, although TCBI was not associated with cardiovascular and cancer mortalities, the association between TCBI and reduced all-cause mortality (hazard ratio: 0.64, 95% confidence interval: 0.44–0.94, p = 0.024) was observed. We computed net reclassification improvement (NRI) when TCBI or Geriatric Nutritional Risk Index (GNRI) was added on established predictors such as hemoglobin, serum sodium level, and both. TCBI improved discrimination for all-cause mortality (NRI: 0.42, p < 0.001; when added on hemoglobin and serum sodium level). GNRI can improve discrimination for cancer mortality (NRI: 0.96, p = 0.002; when added on hemoglobin and serum sodium level). TCBI, a novel and simply calculated nutritional index, can be useful to stratify patients with ADHF who were at risk for worse long-term overall mortality.

scholarly journals Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients

2017 ◽  
Vol 7 (4) ◽  
pp. 362-370 ◽  
Author(s):  
Alexander Jobs ◽  
Ronja Simon ◽  
Suzanne de Waha ◽  
Kyrill Rogacev ◽  
Alexander Katalinic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Prognostic Impact ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
All Cause Mortality

Background: The prognostic impact of pneumonia and signs of systemic inflammation in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. The aim of the present study was thus to investigate the association of pneumonia and the inflammation surrogate C-reactive protein with all-cause mortality in patients admitted for ADHF. Methods: We analysed data of 1939 patients admitted for ADHF. Patients were dichotomised according to the presence or absence of pneumonia. The primary endpoint of all-cause mortality was determined by death registry linkage. Results: In total, 412 (21.2%) patients had concomitant pneumonia. Median C-reactive protein levels were higher in patients with compared to patients without pneumonia (24.9 versus 9.8 mg/l, respectively; P<0.001). All-cause mortality was significantly higher in patients with pneumonia ( P<0.001). In adjusted Cox regression models, pneumonia as well as C-reactive protein were independently associated with in-hospital mortality. Only C-reactive protein remained as independent predictor for long-term mortality. Conclusion: Pneumonia is relatively common in ADHF and a predictor for in-hospital mortality. However, inflammation in general seems to be more important than pneumonia itself for long-term prognosis. Compared to community-acquired pneumonia studies, C-reactive protein levels were rather low and therefore pneumonia might be over-diagnosed in ADHF patients.

P5409Plasma volume status provides the additional prognostic information to the Get With the Guidelines-Heart Failure risk score in acute decompensated heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
M Kawasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Weight ◽  
Risk Score ◽  
Roc Analysis ◽  
Acute Decompensated Heart Failure ◽  
Total Mortality ◽  
Decompensated Heart Failure ◽  
Prognostic Information ◽  
Get With The Guidelines

Abstract Background 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 also reported to be associated with post-discharge long-term outcomes. Plasma volume (PV) expansion plays an essential role in HF. Recently, it has been reported that PV is estimated by a simple formula based on hematocrit and body weight, not using radioisotope assays, and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). However, there is no information available on the long-term prognostic value of the combination of PV status and GWTG-HF risk score in pts admitted for ADHF. Methods and results We studied 301 ADHF pts discharged with survival. 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. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). During a follow-up period of 4.3±3.2 yrs, 95 pts had all-cause death (ACD). At multivariate Cox analysis, GWTG-HF risk score and PV status were significantly associated with the total mortality, independently of eGFR and the prior history of heart failure hospitalization, after the adjustment with serum albumin level and anemia. Pts with both high GWTG-HF risk score (≥39 by ROC analysis; AUC 0.655 [0.586–0.724]) and greater PV status (≥8.1% by ROC analysis; AUC 0.624 [0.566–0.692]) had a significantly higher risk of ACD than those with either or none of them (58% vs 30% vs 21%, p<0.0001, respectively). Conclusion PV status would provide the additional long-term prognostic information to GWTG-HF risk score in ADHF pts.

Abstract 12877: Malnutrition Assessed by Geriatric Nutritional Index Provides the Additional Long-Term Prognostic Information to Renal Dysfunction in Patients Admitted for Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takahisa Yamada ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
Yusuke Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Acute Decompensated Heart Failure ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Heart Failure Hospitalization ◽  
Prognostic Information ◽  
Nutritional Index ◽  
Nutritional Risk Index

Backgrounds: Renal dysfunction has emerged as one of the most potent prognostic indicators in patients with heart failure. Hospitalization for acute decompensated heart failure (ADHF) isassociated with a high mortality after discharge. Malnutrition is also associated with poor outcome in ADHF pts. However, there is no information available on the long-term prognostic significance of malnutrition, relating to renal dysfunction in ADHF patients. Methods and Results: We studied 305 consecutive ADHF patients discharged with survival. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 x serum albumin (g/dl) + 41.7 x body mass index/22. During a follow-up period of 4.2±3.2 yrs, 69 patients had cardiovascular death (CVD). At multivariate Cox analysis, GNRI at discharge (p=0.003) and estimated glomerular filtration rate (GFR) (p=0.03) were significantlyassociated with CVD, independently of systolic blood pressure, serum sodium level and prior heart failure hospitalization. Receiver-operator curve analysis revealed that GNRI of 88 was a fair discriminator for CVD (AUC 0.698 (95%CI 0.628-0.768), p<0.0001). In patients with renal dysfunction defined as low GFR (<the median value:54.5ml/min/1.73m 2 ), CVD was significantly more frequently observed in pts with than without low GNRI <88 (52% vs 26%, p<0.0001, the adjusted hazard ratio (HR):2.7 (95%CI 1.5-4.8)). Furthermore, in group without renal dysfunction, pts with low GNRI had the significantlyincreased risk, compared to those with high GNRI>88 (28% vs 6%, p<0.0001, the adjusted HR:4.7 (95%CI 1.6-13.4)). Conclusion: Malnutrition Assessed by Geriatric Nutritional Index provides the long-term prognostic information in patients admitted for acute decompensated heart failure, irrespective of renal dysfunction.

Impact of simple nutrition index on the long-term mortality of acute decompensated heart failure patients with preserved left ventricular ejection fraction: insight from PURSUIT-HFpEF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kikuchi ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
Y Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Funding Source ◽  
Multicenter Observational Study ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Prospective Multicenter Observational Study

Abstract Background The novel nutrition index; triglyceride (TG) × total cholesterol (TG) × body weight (BW) index (TCBI) has been reported to be an easy and useful predictor for patients with coronary artery disease. However, there is no information available on the prognostic value of TCBI in patients with heart failure with preserved LVEF (HFpEF) who admitted with acute decompensated heart failure (ADHF). Methods and results Data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study. PURSUIT-HFpEF study is a prospective multicenter observational study in which collaborating hospitals recorded clinical, echocardiographic, and outcome data of ADHF pts with HFpEF. We enrolled consecutive 757 HFpEF patients who admitted with ADHF from June 2016 to June 2019. TCBI was calculated by the formula; TG × TC × BW / 1000 at the discharge. After we excluded patients with in-hospital death or without sufficient data, we analyzed 419 patients. The primary endpoint was all-cause mortality. During a median follow up period of 1.1 (0.9–1.9) years, 59 patients died. ROC analysis revealed that TCBI at discharge was a fair discriminator for predicting all-cause mortality (AUC 0.676, sensitivity 53%, specificity 78%). Multivariate Cox proportional analysis showed that TCBI (p=0.002) was an independent predictor for all cause death after adjustment with major confounders such as age, gender, NT-proBNP, hemoglobin and serum creatinine level. We divided patients into 4 groups according to quartiles of TCBI. Kaplan-Meier analysis showed a significantly higher risk of all-cause death in relation to the decrease in TCBI. Conclusion TCBI, a simple and novel nutrition index, is a useful and strong long-term prognostic indicator in ADHF patients with HFpEF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Roche Diagnositics K.K.; Fuji Film Toyoma Chemical Co. Ltd.

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