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Vol. 157. Issue 8.
Pages 371-379 (October 2021)
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Vol. 157. Issue 8.
Pages 371-379 (October 2021)
Original article
Prognostic value of malnutrition in patients with acute heart failure and its influence on the interpretation of markers of systemic venous congestion
Valor pronóstico de la desnutrición en pacientes con insuficiencia cardíaca aguda y su influencia en la interpretación de marcadores de congestión venosa sistémica
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Jorge Rubio-Graciaa,b,
Corresponding author
jorgerubiogracia@gmail.com

Corresponding author.
, Claudia Josa-Laordena,b, Marta Sánchez-Martelesa,b, Ignacio Giménez-Lópezb,c,d, Vanesa Garcés Hornaa,b, José Luis Morales Rulle, Juan Ignacio Pérez-Calvoa,b,c
a Servicio de Medicina Interna, Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain
b Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
c Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
d Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
e Servicio de Medicina Interna, Hospital Universitario Arnau de Villanova, Lérida, Spain
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Tables (2)
Table 1. Baseline characteristics according to the CONUT index on admission.
Table 2. Baseline characteristics according to the PNI index.
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Abstract
Background

Malnutrition is frequent in patients with heart failure (HF) and contributes to increased systemic congestion, but also hinders its correct assessment, especially during decompensations. Estimating the degree of malnutrition and its relationship with systemic congestion is important to optimize treatment during decompensations.

Material and methods

Retrospective cohort study in patients with acute HF. The population was stratified according to CONUT (Controlling Nutritional Status) and PNI (Prognostic Nutritional Index) nutrition indices in order to analyse their relationship with objective parameters of congestion and the prognostic value of malnutrition.

Results

309 patients were included. More than half presented some degree of malnutrition upon admission. The degree of congestion was significantly higher in malnourished patients, with a higher proportion of «comet tail artifacts» and a higher relative plasma volume. NT-proBNP concentrations, both on admission and at discharge, were also significantly higher in malnourished patients, regardless of the scale used. The univariate analysis identified the CONUT and PNI index as factors associated with one-year mortality from any cause (HR 1.62 [1.22–2.14]; p = 0.001) and PNI (HR 65 [0.53–0.80]; p ≤ 0.001), respectively.

Conclusions

A higher degree of malnutrition (determined by means of the CONUT and PNI indices) in patients with acute HF was associated with a higher presence of objective parameters of congestion and a higher one-year all-cause mortality.

Keywords:
Heart failure
Malnutrition
Cardio-renal syndrome
Congestion
Resumen
Antecedentes

La desnutrición es frecuente en los pacientes con insuficiencia cardíaca (IC). Dicha situación contribuye al incremento de la congestión sistémica dificultando el manejo clínico. Cuantificar la desnutrición y su relación con la congestión sistémica, es importante para optimizar el tratamiento durante la fase aguda.

Material y métodos

Estudio de cohortes retrospectivo en pacientes con diagnóstico de IC aguda. La población se estratificó según los índices de nutrición de CONUT (Controlling Nutritional Status) y PNI (Prognostic Nutritional Index) con el objetivo de analizar su relación con parámetros objetivos de congestión y el valor pronóstico al año de seguimiento.

Resultados

Se incluyeron un total de 309 pacientes, presentando más de la mitad algún grado de desnutrición al ingreso. El grado de congestión fue significativamente superior en los pacientes desnutridos, con una mayor proporción de «líneas b» y un mayor volumen plasmático relativo. Las concentraciones de la prohormona N-terminal del péptido natriurético cerebral (NT-proBNP), tanto al ingreso como al alta, también fueron significativamente superiores en los pacientes desnutridos, independientemente de la escala empleada. El análisis univariante identificó el índice de CONUT y PNI, como factores asociados a la mortalidad al año para todas las causas (HR 1,62 [1,22–2,14]; p = 0,001) y de PNI (HR 0,65 [0,53–0,80]; p = <0,001), respectivamente.

Conclusiones

Un mayor grado de desnutrición (determinado mediante los índices de CONUT y PNI) en pacientes con IC aguda, se asoció a una mayor presencia de parámetros objetivos de congestión y a una mayor mortalidad al año para todas las causas.

Palabras clave:
Insuficiencia cardíaca
Desnutrición
Síndrome cardio-renal
Congestión

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