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Prognostic nutrition index predicts prognosis in ultra-elderly patients with heart failure

Session Poster Session 1

Speaker Takayuki Kawata

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : T Kawata (Tokyo,JP), A Ikeda (Tokyo,JP), S Komatsu (Tokyo,JP)

T Kawata1 , A Ikeda1 , S Komatsu1 , 1Sassa General Hospital, Department of Cardiology - Tokyo - Japan ,


Background:  The prognostic nutritional index (PNI), calculated from the serum albumin concentration and total lymphocyte count, is a simple and objective indicator of postoperative outcomes in patients undergoing cancer surgery.  Recent studies have shown that PNI is associated with long-term survival in patients hospitalized for acute heart failure.  However, the clinical significance of nutritional risk assessment in ultra-elderly patients with heart failure has not been well established.
Purpose:  To test the hypothesis that PNI predicts prognosis in ultra-elderly patients with hospitalized heart failure.
Methods:  We enrolled consecutive 48 octogenarian or nonagenarian patients (mean age 86 ± 4 years, 23 male) who were admitted to our hospital for treatment of heart failure.  The diagnosis of heart failure was based on the Framingham criteria.  Patients with significant (moderate or severe) primary valve disease were not included in this study.  Vital status, information about medical treatment, laboratory data and echocardiographic data before discharge were collected from medical records.  According to previous reports, PNI > 40 was considered normal value.  The date of discharge was considered the entry time-point of observation.  Primary outcomes were defined as cardiac death and unplanned hospitalization due to congestive heart failure.
Results:  During a median follow-up of 291 days (range, 5 to 1331 days), 23 events (5 deaths, 18 heart failures) occurred.  Compared with event free patients, plasma log BNP was significantly higher (2.58 ± 0.36 vs 2.26 ± 0.32, p < 0.01), PNI was significantly lower (35.8 ± 4.9 vs 41.6 ± 4.7, p < 0.01), and hemoglobin was significantly lower (10.5 ± 1.8 g/dl vs 11.8 ± 1.8 g/dl, p < 0.05) in patients with events.  Univariate analysis showed that plasma log BNP (hazard ratio [HR] 6.1, 95% confidence interval [CI] 1.7 - 23.4, p < 0.01) and PNI (HR 0.89, 95% CI 0.82 - 0.96, p < 0.01) were predictors of outcome.  Although lower hemoglobin level tended to associated with outcome (p = 0.066), none of the echocardiographic parameters were associated with outcome.  Multivariate analysis revealed that both plasma log BNP (HR 4.2, 95% CI 1.2 – 16.0, p < 0.05) and PNI (HR 0.91, 95% CI 0.83 - 0.98, p < 0.01) were independent outcome predictors.  Kaplan-Meier analysis showed that event rate was markedly higher (log rank, p < 0.01) in patients with PNI = 40 than in those with PNI > 40.
Conclusion:  Malnutrition, as evaluated using PNI, was associated with unfavorable outcomes even in ultra-elderly patients with heart failure.

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