Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation
Background: Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores – geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) –...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001113 |
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| author | Tae Kyung Yoo, MD, MS Satoshi Miyashita, MD Ariella Stein, MSCIS-HI Michael Wu, BS, MPH Lauren Parsly Read-Button, MPH, RD, LDN Masashi Kawabori, MD Greg S. Couper, MD Edward Saltzman, MD Amanda R. Vest, MBBS, MPH |
| author_facet | Tae Kyung Yoo, MD, MS Satoshi Miyashita, MD Ariella Stein, MSCIS-HI Michael Wu, BS, MPH Lauren Parsly Read-Button, MPH, RD, LDN Masashi Kawabori, MD Greg S. Couper, MD Edward Saltzman, MD Amanda R. Vest, MBBS, MPH |
| author_sort | Tae Kyung Yoo, MD, MS |
| collection | DOAJ |
| description | Background: Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores – geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) – have the strongest mortality association for HT candidates, and whether they are prognostic at the time of HT listing or HT operation. Methods: We reviewed adults listed for primary HT at a single center 1987–March 2022, with survival follow-up to November 2022. We constructed Cox proportional hazards models and restricted cubic spline curves for each risk score at both HT listing and HT operation and inputted HT operation as a time-varying covariate for models commencing at listing. Risk scores were assessed as continuous and binary variables. Weight change between listing and HT was evaluated similarly. Results: The 1,024 patients [76% male; median age 55 (46–61) years; HT operation n = 656] had median follow-up of 4.6 (interquartile range 1.6–8.7) years. As a continuous variable, lower GNRI at HT listing (greater malnutrition risk) was independently associated with higher mortality. As binary variables, higher risk GNRI, PNI or CONUT scores at listing were all associated with higher mortality. Conversely, risk scores at time of HT operation were not associated with subsequent mortality. There was a non-significant trend towards higher mortality with greater weight loss between listing and HT operation. Conclusion: Malnutrition risk scores showed prognostic utility only at time of HT listing. As a continuous variable, GNRI at HT listing was independently associated with subsequent mortality. |
| format | Article |
| id | doaj-art-24af45bfa89245b2a66678de1b88183d |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-24af45bfa89245b2a66678de1b88183d2025-02-09T05:01:52ZengElsevierJHLT Open2950-13342025-02-017100162Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantationTae Kyung Yoo, MD, MS0Satoshi Miyashita, MD1Ariella Stein, MSCIS-HI2Michael Wu, BS, MPH3Lauren Parsly Read-Button, MPH, RD, LDN4Masashi Kawabori, MD5Greg S. Couper, MD6Edward Saltzman, MD7Amanda R. Vest, MBBS, MPH8Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MassachusettsDepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDivision of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MassachusettsDivision of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MassachusettsFrances Stern Nutrition Center, Tufts Medical Center, Boston, MassachusettsDivision of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, MassachusettsDivision of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, MassachusettsFriedman School of Nutrition Science and Policy at Tufts University, Boston, MassachusettsDepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Massachusetts; Corresponding author: Amanda R. Vest, MBBS, MPH, Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, Ohio. Telephone: (216) 444-7646.Background: Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores – geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) – have the strongest mortality association for HT candidates, and whether they are prognostic at the time of HT listing or HT operation. Methods: We reviewed adults listed for primary HT at a single center 1987–March 2022, with survival follow-up to November 2022. We constructed Cox proportional hazards models and restricted cubic spline curves for each risk score at both HT listing and HT operation and inputted HT operation as a time-varying covariate for models commencing at listing. Risk scores were assessed as continuous and binary variables. Weight change between listing and HT was evaluated similarly. Results: The 1,024 patients [76% male; median age 55 (46–61) years; HT operation n = 656] had median follow-up of 4.6 (interquartile range 1.6–8.7) years. As a continuous variable, lower GNRI at HT listing (greater malnutrition risk) was independently associated with higher mortality. As binary variables, higher risk GNRI, PNI or CONUT scores at listing were all associated with higher mortality. Conversely, risk scores at time of HT operation were not associated with subsequent mortality. There was a non-significant trend towards higher mortality with greater weight loss between listing and HT operation. Conclusion: Malnutrition risk scores showed prognostic utility only at time of HT listing. As a continuous variable, GNRI at HT listing was independently associated with subsequent mortality.http://www.sciencedirect.com/science/article/pii/S2950133424001113heart transplantheart failuremalnutritionmortalityweight loss |
| spellingShingle | Tae Kyung Yoo, MD, MS Satoshi Miyashita, MD Ariella Stein, MSCIS-HI Michael Wu, BS, MPH Lauren Parsly Read-Button, MPH, RD, LDN Masashi Kawabori, MD Greg S. Couper, MD Edward Saltzman, MD Amanda R. Vest, MBBS, MPH Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation JHLT Open heart transplant heart failure malnutrition mortality weight loss |
| title | Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation |
| title_full | Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation |
| title_fullStr | Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation |
| title_full_unstemmed | Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation |
| title_short | Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation |
| title_sort | malnutrition risk weight loss and subsequent survival in patients listed for heart transplantation |
| topic | heart transplant heart failure malnutrition mortality weight loss |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001113 |
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