P3397Prognostic utility of multipoint nutritional screening in hospitalized patients with acute decompensated heart failure

Abstract

Purpose: Malnutrition has been shown as an important prognostic factor for acute decompensated heart failure (ADHF), however, appropriate measuring timing or comparison between each measurement is not to be elucidated. The purpose of the study was to evaluate the impact of nutritional status on 1-year events (all-cause mortality or rehospitalization due to heart failure) among hospitalized patients with ADHF in Japan. Method: Between November 2009 and August 2015, a total of 253 consecutive patients with ADHF were examined, and they were followed up for 1-year. We evaluated nutritional status using the Controlling nutritional status (CONUT) score, calculated from serum albumin level, total cholesterol concentration, and total lymphocyte count. The CONUT scores were assessed both at hospital admission and discharge. Study subjects were divided into three groups: normal (0 and 1), mild risk (2 to 4), and moderate to severe risk defined as malnutrition (5 to 12), and were observed the presence or absence of improvement in nutritional status. We calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) to evaluate the improvement of prediction ability on 1-year events. Results: The average age was 78 (interquartile range 70-86) years old, and 53.8% of patients were male. The frequency of malnutrition was 30.4% or 23.7% at hospital admission and discharge, respectively. The 1-year events occurred in 26.5%. Malnutrition at hospital discharge and absence of improvement of malnutrition were significantly related to the occurrence of 1-year events by univariate cox regression analysis [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.05-1.75, P=0.021; HR 1.75, 95% CI 1.33-2.37, P<0.001, respectively]. However, there was no relation of malnutrition at hospital admission to 1-year events. We determined a reference model including gender (HR 0.71, 95% CI 0.52-0.96, P=0.028), and estimated glomerular filtration rate (HR 0.98, 95% CI 0.97-0.99, P<0.001) by multivariable cox regression analysis (P<0.05). Adding absence of improvement in nutritional status during hospitalization to the reference model significantly improved both NRI and IDI (NRI 0.563, P<0.001; IDI 0.039, P=0.001). Similarly, adding malnutrition at hospital discharge significantly improved NRI (0.256, P=0.036), whereas IDI was not improved. Conclusion: Our study revealed that malnutrition was relatively common in hospitalized patients with ADHF. And the absence of improvement in nutritional status through hospital admission to discharge significantly increased prediction ability for 1-year events. We suggest that serial change in nutritional status by evaluating multiple measurements may provide more useful information in the prediction of 1-year events than single measurement at hospital admission or discharge among hospitalized patients with ADHF in Japan.