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Malnutrition in acute decompensated heart failure.
Session:
Painel 1 - Insuficiência Cardíaca 9
Speaker:
Maria Luísa Malvar Azevedo Magalhães Gonçalves
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Maria Luisa Gonçalves; João Miguel Santos; Hugo Da Silva Antunes; Inês Pires; Joana Laranjeira Correia; Inês Almeida; Davide Moreira; José Costa Cabral
Abstract
<p><strong>Introduction:</strong> Malnutrition (M) can lead to cardiac cachexia and sarcopenia, two known risk factos for worse prognosis in heart failure (HF), leading to increased mortality. Score system tools are an easy way to screen patients at risk. The M universal screening tool (MUST), the nutritional inflammatory index (IIN) and the Glasgow Prognostic Score (GPs) are 3 easy tools validated in the care settings that help differentiate high risk patients.</p> <p><strong>Objectives:</strong> Study the prevalence of M in patients admitted for acute HF (AHF), using M scores and compare their performance on terms of prognosis.</p> <p><strong>Methods: </strong>Selected all patients admitted to a cardiology ward between 2010-15 with AHF. MUST, IIN and GPs were calculated. MUST score as the summation of 2 of its original 3 components (BMI>20Kg/m2 – 0 points (pts), 18.5-20Kg/m2 – 1 point (pt), <18.5Kg/m2 – 2 pts; unwanted weight loss (as the subtraction of Ideal body weight (IBW) and actual body weight; <5% - 0 pts, 5-10% - 1 pt and >10% - 2 pts); Total: 0 pts – low risk, 1 pt – intermediate risk, 2 pts – high-risk). IBW calculated with <em>Devine </em>formula. IIN score as the ratio of PCR/Albumin (<0.4 as without risk – 0 pts, 0.4-1.1 as lower risk – 1 pt, 1.2-1.9 as intermediate risk – 2 pts, and >2.0 as hig-risk – 3 pts). GPs score as the summation of 2 components (PCR>10mg/L – 1 pt, PCR<10mg/L – 0 pts; Albumin<3.5g/L – 1 pt, Albumin>3.5g/L – 1 pts; 0 pts – low risk, 1 pt – intermediate risk, 2 pts – high-risk). Follow up (FU) for up to 2 years. Endpoints: in-hospital death (IHD), readmission for HF and death. Using association analysis and performance analysis, we inferred associations between M and endpoints and comparison between the 3 scores </p> <p><strong>Results:</strong> Initial population of 797 patients with median age of 79 [31-99] years. 50.8% males. IHD in 6.9%, Death 24 months 18.6%, readmission for AHF at 24 months 43.3%. </p> <p>Median of GP score 0 [0-2], IIN 0.4 [0.01-7.59] and MUST 0[0-4] points. The prevalence of high-risk malnourished patients was 1.6% with GP, 3.9% with MUST and 6.2% with IIN score. </p> <p>Regarding IHD, there was a significant association between intermediate-high risk score by IIN (11.1% vs 5.3%, p=0.02), but not with GPs and MUST score, with an odds-ratio of 2.25 [1.23-4.48]. </p> <p>On FU, no high-risk score was associated with readmission for HF. Regarding death on FU, high-risk IIN was associated with early (3-12 months) death (26.3% vs 14%, p=0.04), and high-risk MUST was associated with late (6-24 months) death (35.7% vs 9.4%, p=0.002). </p> <p>ROC curve confirms that IIN has a better performance (AUC 0.642) than GPs (AUC 0.571) and MUST score (AUC 0.458) in predicting IHD, and at mid-FU (12 months), IIN score has the best performance (IIN AUC 0.629 > MUST AUC 0.606 > GPs AUC 0.510) in predicting death at 12 months.</p> <p><strong>Conclusion:</strong> Malnourished patients were infrequent in our study, but the prognosis associated and evaluated by M scores was helpful identifying HF patients with a worse P.</p>
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