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Modified versus conventional body mass index in patients admitted due to acute heart failure: association with adverse prognosis.
Session:
Comunicações Orais (Sessão 26) - Insuficiência Cardíaca 4 - Vários Tópicos
Speaker:
Vanda Neto
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vanda Devesa Neto; João Miguel Santos; Inês Pires; Joana Laranjeira Correia; Gonçalo Ferreira; Luis Ferreira Santos
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Conventional body mass index (cBMI) and serum albumin (SA) are frequently used to predict malnutrition status. cBMI does not reflect fluid accumulation, so modified body mass index (mBMI) (SA x cBMI) has recently emerged as a marker for poor prognosis and mortality in critically ill patients. However, there is limited evidence of the impact of mBMI in patients with Acute Heart Failure (HF).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Identify the association between mBMI and 12-month (12MM) mortality compared with cBMI in patients admitted with acute HF. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Retrospective study of 264 patients admitted for acute heart failure in a Cardiology Department. Baseline characteristics, laboratory findings, and disease severity were analyzed. BMI and SA were measured at admission, and mBMI was calculated for each patient. Analysis of the receiver operating characteristic (ROC) curves was performed to evaluate mBMI and cBMI predictive value for post-hospitalization mortality. Kaplan-Meyer survival plots were used to assess 12MM. The Mann-Whitney U test was used for mean comparison between groups.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Mean age was 75,0±11,4 years; 51% were men. Mean left ventricular ejection fraction (LVEF) was 46,6±16,7%. Mean SA and BMI values were 3,8±0,5 g/dL and 27,0±9,8 kg/m2, respectively. 7% received inotropic treatment. 1,1% presented with cardiogenic shock at admission. The optimal cut-off point for cBMI assessed by Youden index was 22,2 (sensitivity (S)≈39% and specificity (E)≈86%; Youden index (IY=)0,2411) and the optimal cut-off point for mBMI was 107,2 (S≈81% and E≈49%; IY=0,3005). 45% of patients had mBMI higher than 107,3 and 55% had mBMI lower than 107,3. 82% of patients had cBMI higher than 22,2 and 18% had cBMI lower than 22,2. Lower mBMI was correlated with 12MM (p<0,01), treatment with inotropes during hospital stay (p=0,05), age (p<0,01), LVEF (p=0,05) and number of days of hospitalization (p<0,01). Lower cBMI was correlated with 12MM (p<0,01) and age (p<0,01). In survival analysis, both cBMI (18% vs 7%; p<0,01; </span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">χ</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">2</span></span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> 7,9) and mBMI (13% vs 5%; p<0,01; </span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">χ</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">2</span></span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> 8,5) were associated with 12MM. ROC curve analysis revealed that mBMI had the best predictive performance for 12MM (AUC 0,661; p<0,01; CI 95% 0,596;0,721) compared to cBMI (AUC 0,603; p=0,13; CI 95% 0,537;0,666). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Both cBMI and mBMI have a significant association with 12MM. mBMI has a better predictive performance for 12MM than cBMI and should be considered to assess malnutrition status and prognostic impact in patients with heart failure. </span></span></span></span></span></p>
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