Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure - PubMed (original) (raw)

Observational Study

. 2020 Oct 29;12(11):3311.

doi: 10.3390/nu12113311.

Shoichiro Yatsu 1, Takatoshi Kasai 1 2 3, Akihiro Sato 1 2, Hiroki Matsumoto 1, Jun Shitara 1, Megumi Shimizu 1, Azusa Murata 1, Takao Kato 1, Shoko Suda 1 2, Shinichiro Doi 1, Masaru Hiki 1, Yuya Matsue 1 2, Ryo Naito 1 2, Hiroshi Iwata 1, Atsutoshi Takagi 1, Hiroyuki Daida 1

Affiliations

Observational Study

Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure

Sayaki Ishiwata et al. Nutrients. 2020.

Abstract

The TCB index (triglycerides × total cholesterol × body weight), a novel simply calculated nutritional index based on serum triglycerides (TGs), serum total cholesterol (TC), and body weight (BW), was recently reported to be a useful prognostic indicator in patients with coronary artery disease. Thus, this study aimed to investigate the relationship between TCBI and long-term mortality in acute decompensated heart failure (ADHF) patients. Patients with a diagnosis of ADHF who were consecutively admitted to the cardiac intensive care unit in our institution from 2007 to 2011 were targeted. TCBI was calculated using the formula TG (mg/dL) × TC (mg/dL) × BW (kg)/1000. Patients were divided into two groups according to the median TCBI value. An association between admission TCBI and mortality was assessed using univariable and multivariable Cox proportional hazard analyses. Overall, 417 eligible patients were enrolled, and 94 (22.5%) patients died during a median follow-up period of 2.2 years. The cumulative survival rate with respect to all-cause, cardiovascular, and cancer-related mortalities was worse in patients with low TCBI than in those with high TCBI. In the multivariable analysis, although TCBI was not associated with cardiovascular and cancer mortalities, the association between TCBI and reduced all-cause mortality (hazard ratio: 0.64, 95% confidence interval: 0.44-0.94, p = 0.024) was observed. We computed net reclassification improvement (NRI) when TCBI or Geriatric Nutritional Risk Index (GNRI) was added on established predictors such as hemoglobin, serum sodium level, and both. TCBI improved discrimination for all-cause mortality (NRI: 0.42, p < 0.001; when added on hemoglobin and serum sodium level). GNRI can improve discrimination for cancer mortality (NRI: 0.96, p = 0.002; when added on hemoglobin and serum sodium level). TCBI, a novel and simply calculated nutritional index, can be useful to stratify patients with ADHF who were at risk for worse long-term overall mortality.

Keywords: acute decompensated heart failure; nutritional index; prognosis.

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Conflict of interest statement

Takatoshi Kasai, Shoko Suda, and Sayaki Ishiwata are affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi. H. Daida received manuscript fees, research funds, and scholarship funds from Kirin Co. Ltd., Kaken Pharmaceutical Co., Ltd., Abbott Japan Co., Ltd., Astellas Pharma Inc., AstraZeneca K.K., Bayer Yakuhin, Ltd., Boston Scientific Japan K.K., Bristol-Myers Squibb, Daiichi Sankyo Company, MSD K.K., Pfizer Inc., Philips Respironics, Sanofi K.K., and Takeda Pharmaceutical Co. Ltd. The remaining authors report no conflicts of interest.

Figures

Figure 1

Figure 1

Cumulative event-free survival curves of all-cause, cardiovascular, and cancer deaths in patients with acute decompensated heart failure (ADHF). (a) Cumulative event-free survival curves of all-cause deaths in patients with ADHF. In the lower TCB index (TCBI) group, the cumulative incidence of all-cause deaths significantly increased compared with the higher TCBI (log-rank test: p < 0.001). (b) Cumulative event-free survival curves of cardiovascular deaths in patients with ADHF. In the lower TCBI group, the cumulative incidence of cardiovascular deaths significantly increased compared with the higher TCBI (log-rank test: p < 0.041). (c) Cumulative event-free survival curves of cancer deaths in patients with ADHF. In the lower TCBI group, the cumulative incidence of cancer deaths significantly increased compared with the higher TCBI (log-rank test: p < 0.031).

Figure 2

Figure 2

The correlation between TCBI and Geriatric Nutritional Risk Index (GNRI). TCBI was mildly correlated with GNRI (correlation coefficient = 0.287, 95% confidential interval (CI) 0.191–0.378, p < 0.0001).

Figure 3

Figure 3

Prognostic implications of TCBI and GNRI for all-cause, cardiovascular, and cancer deaths. Receiver operating characteristic (ROC) curves of TCBI and GNRI with reference line for all-cause (a), cardiovascular (b), and cancer deaths (c). AUC: area under the curve.

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