Journal Article

Effects of malnutrition on disease severity and adverse outcomes in idiopathic pulmonary arterial hypertension: a retrospective cohort study

Zhao, Qing, Yang, Tao, Luo, Qin, Zhao, Zhihui, Duan, Anqi, Wang, Yijia, Liu, Zhihong, Li, Xin, Zhang, Sicheng, Gao, Luyang, Zeng, Qixian, Huang, Zhihua, Li, Sicong

2024

Overview

Background Malnutrition is common in patients with chronic cardiovascular disease and is associated with significantly higher all-cause mortality. Approximately one-third of patients with heart failure are malnourished. However, the relationship between malnutrition and idiopathic pulmonary arterial hypertension (IPAH) remains unclear. This study aimed to clarify the prognostic value of malnutrition in patients with IPAH. Methods A total of 432 consecutive participants with IPAH were included in this study between March 2013 and August 2021. Three common malnutrition assessment tools, including the geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score, were used to evaluate the nutritional status of patients with IPAH. The relationships between the malnutrition tools and long-term adverse outcomes were determined using restricted cubic splines and multivariate Cox regression models. Results During a mean follow-up of 3.1 years, 158 participants experienced clinical worsening or all-cause death. Patients were stratified into the low-, intermediate- and high-risk groups based on the European Society of Cardiology (ESC) risk stratification, and the PNI (55.9 ± 5.7 vs. 54.4 ± 7.2 vs. 51.1 ± 7.1, P = 0.005) and CONUT score (2.1 ± 0.9 vs. 2.5 ± 1.2 vs. 3.3 ± 1.1, P < 0.001) identified these patient groups better than the GNRI. All three malnutrition tools were associated with well-validated variables that reflected IPAH severity, such as the World Health Organization functional class, 6-min walk distance, and N-terminal pro-brain natriuretic peptide level. The CONUT score exhibited better predictive ability than both the GNRI (ΔAUC = 0.059, P < 0.001) and PNI (ΔAUC = 0.095, P < 0.001) for adverse outcomes and significantly improved reclassification and discrimination beyond the ESC risk score. Multivariable Cox regression analysis indicated that only the CONUT score (hazard ratio = 1.363, 95% confidence interval 1.147, 1.619 per 1.0-standard deviation increment, P < 0.001) independently predicted adverse outcomes. Conclusions The malnutrition status was associated with disease severity in patients with IPAH. The CONUT score provided additional information regarding the risk of clinically worsening events, making it a meaningful risk stratification tool for these patients.

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Adult / Aged / Analysis / Body mass index / Brain natriuretic peptide / Cardiac patients / Cardiology / Cardiovascular diseases / Care and treatment / Chronic illnesses / Cohort analysis / Cohort Studies / Complications and side effects / Confidence intervals / Congestive heart failure / Controlling nutritional status / Development and progression / Disease / Ethnicity / Familial Primary Pulmonary Hypertension - diagnosis / Familial Primary Pulmonary Hypertension - mortality / Familial Primary Pulmonary Hypertension - physiopathology / Female / Follow-Up Studies / Functional morphology / Health aspects / Heart failure / Hemodynamics / Humans / Hypertension / Idiopathic pulmonary arterial hypertension / Male / Malnutrition / Malnutrition - diagnosis / Malnutrition - epidemiology / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Mortality / Natriuretic peptides / Nutrition Assessment / Nutritional Status / Outcome / Patients / Pneumology/Respiratory System / Prevention / Prognosis / Proteins / Pulmonary arteries / Pulmonary hypertension / Regression analysis / Regression models / Retrospective Studies / Risk / Risk Assessment - methods / Risk Factors / Risk groups / Severity / Severity of Illness Index / Statistical analysis / Veins & arteries