Risk stratification based on nutritional screening on admission: Three-year clinical outcomes in hospitalized patients with acute heart failure syndrome

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• 作者：Masashi Fujino ; MD^a ; ^b ; Hiroyuki Takahama ; MD ; PhD^a ; ^{takahama@ncvc.go.jp" class="auth_mail" title="E-mail the corresponding author} ; Toshimitsu Hamasaki ; PhD^c ; Kenichi Sekiguchi ; MD ; PhD^a ; Kengo Kusano ; MD ; PhD ; FJCC^a ; ^b ; Toshihisa Anzai ; MD ; PhD ; FJCC^a ; ^b ; Teruo Noguchi ; MD ; PhD^a ; ^b ; Yoichi Goto ; MD ; PhD ; FJCC^a ; Masafumi Kitakaze ; MD ; PhD ; FJCC^a ; Hiroyuki Yokoyama ; MD ; PhD^a ; Hisao Ogawa ; MD ; PhD ; FJCC^a ; ^d ; Satoshi Yasuda ; MD ; PhD ; FJCC^a ; ^b
• 关键词：Nutrition ; Acute heart failure ; Albumin ; Lymphocyte counts ; Prognosis
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：392-398
• 全文大小：762 K

文摘

Several blood tests are commonly used to assess nutritional status, including serum albumin levels (SAL) and lymphocyte counts (LC). The aim of this study is to investigate whether nutritional screening on admission can be used to determine risk levels for adverse clinical events in acute heart failure syndrome (AHFS) patients.

Methods

In 432 consecutive AHFS patients, we measured SAL and LC and prospectively followed the patients for their combined clinical events (all-cause death and re-hospitalization for heart failure) for three years from admission. The classification and regression tree (CART) tool identified the cut-off criteria for SAL and LC to differentiate among patients with different risks of clinical events as 3.5 g/dl and 963/mm³, respectively.

Results

The CART tool classified 15.5% patients as high risk, 15.7% as intermediate risk, and 68.8% as low risk. The CART for nutritional status (CART-NS) values were strongly correlated with combined clinical events [hazard ratio of 2.13 (low vs high risk), 95% confidence interval of 1.42–3.16, p < 0.001], even after adjusting for plasma brain natriuretic peptide levels. The CART-NS analysis improved the specificity (89.5%) of predictions of clinical outcomes with the comparable sensitivity (36.3%) compared with the use of a single criterion (SAL <3.5 g/dl: 70.2, 42.4% or LC <963/mm³: 73.4, 41.7%, respectively).

Conclusion

A substantial proportion of AHFS patients are at risk of malnutrition, and this risk is associated with poor clinical outcomes. We demonstrate that this algorithm for nutritional screening, even in emergency clinical settings, can determine risk levels for further adverse events in AHFS patients.