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Prognostic impact of a novel index of nutrition and inflammation for patients with acute decompensated heart failure

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Abstract

Malnutrition and systemic inflammation are associated with poor outcomes in patients with heart failure. Recent studies have reported that the advanced lung cancer inflammation index (ALI), derived from the body mass index (BMI), serum albumin level, and neutrophil-to-lymphocyte ratio (NLR), is associated with poor prognosis in several types of cancers. Each marker is also known to prognostic factor of heart failure. Therefore, we hypothesized that ALI may be useful for determining the prognosis of patients with acute decompensated heart failure (ADHF). We reviewed survival in 381 consecutive patients (age, 73.1 ± 11.4 years, 59% men) who were hospitalized for ADHF and discharged. ALI at discharge, calculated as BMI × albumin level/NLR, was used to divide the patients into tertiles (ALI < 23.88, 23.88 ≤ ALI < 42.43, and ALI ≥ 42.43). The patients were also stratified into six groups according to the ALI tertiles and median concentration (177 pg/mL) of brain natriuretic peptide (BNP). The primary endpoint comprised all-cause mortality and readmission because of heart failure. The median follow-up duration was 363 days (interquartile range: 147–721 days), and 166 patients (44%) experienced the primary endpoint. Kaplan–Meier analysis showed that the event rate decreased progressively from the first to the third ALI tertile (52%, 48%, and 31%, respectively; p = 0.0013). In a multivariate Cox proportional hazards model, the first tertile was an independent prognostic factor for the primary endpoint (third vs. first tertile: hazard ratio, 0.57; 95% confidence interval, 0.34–0.95; p = 0.031). The hazard ratio for the primary endpoint for the patients with high BNP and first tertile ALI relative to the patients with low BNP and third tertile ALI was 5.3 (95% confidence interval, 2.9–9.5; p < 0.001). ALI at discharge, a novel and simple index of nutrition and inflammation, may be useful for risk stratification and predicting the prognosis of patients with ADHF.

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References

  1. Metra M, Teerlink JR (2017) Heart failure. Lancet 390(10106):1981–1995

    PubMed  Google Scholar 

  2. Dick SA, Epelman S (2016) Chronic heart failure and inflammation: what do we really know? Circ Res 119(1):159–176

    CAS  PubMed  Google Scholar 

  3. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, Capodilupo R (2011) Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 107(3):433–438

    PubMed  Google Scholar 

  4. Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Tang WH (2015) Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 115(1):57–61

    PubMed  Google Scholar 

  5. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G, Banai S (2012) Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 225(2):456–460

    CAS  PubMed  Google Scholar 

  6. Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, Yuzgecer H, Kurt M, Karakas MF, Basar N, Hajro E, Kanbay M (2013) The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Atherosclerosis 228(1):203–210

    CAS  PubMed  Google Scholar 

  7. Aziz EF, Javed F, Pratap B, Musat D, Nader A, Pulimi S, Alivar CL, Herzog E, Kukin ML (2011) Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis. Heart Int 6(1):e2

    PubMed  PubMed Central  Google Scholar 

  8. Kaneko H, Suzuki S, Goto M, Yuzawa Y, Arita T, Yagi N, Murata N, Kato Y, Kano H, Matsuno S, Otsuka T, Uejima T, Takai H, Oikawa Y, Kunihara T, Nagashima K, Kirigaya H, Sagara K, Sawada H, Aizawa T, Yajima J, Yamashita T (2015) Geriatric nutritional risk index in hospitalized heart failure patients. Int J Cardiol 181:213–215

    PubMed  Google Scholar 

  9. Liu M, Chan CP, Yan BP, Zhang Q, Lam YY, Li RJ, Sanderson JE, Coats AJ, Sun JP, Yip GW, Yu CM (2012) Albumin levels predict survival in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 14(1):39–44

    CAS  PubMed  Google Scholar 

  10. Ancion A, Allepaerts S, Oury C, Gori AS, Pierard LA, Lancellotti P (2017) Serum albumin level and hospital mortality in acute non-ischemic heart failure. ESC Heart Fail 4(2):138–145

    PubMed  PubMed Central  Google Scholar 

  11. Uthamalingam S, Kandala J, Daley M, Patvardhan E, Capodilupo R, Moore SA, Januzzi JL Jr (2010) Serum albumin and mortality in acutely decompensated heart failure. Am Heart J 160(6):1149–1155

    CAS  PubMed  Google Scholar 

  12. Bonilla-Palomas JL, Gamez-Lopez AL, Moreno-Conde M, Lopez-Ibanez MC, Anguita-Sanchez M, Gallego de la Sacristana A, Garcia-Catalan F, Villar-Raez A (2014) Hypoalbuminemia in acute heart failure patients: causes and its impact on hospital and long-term mortality. J Card Fail 20(5):350–358

    CAS  PubMed  Google Scholar 

  13. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS (2002) Obesity and the risk of heart failure. N Engl J Med 347(5):305–313

    PubMed  Google Scholar 

  14. Shah R, Gayat E, Januzzi JL Jr, Sato N, Cohen-Solal A, diSomma S, Fairman E, Harjola VP, Ishihara S, Lassus J, Maggioni A, Metra M, Mueller C, Mueller T, Parenica J, Pascual-Figal D, Peacock WF, Spinar J, van Kimmenade R, Mebazaa A, Network G (2014) Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. J Am Coll Cardiol 63(8):778–785

    PubMed  Google Scholar 

  15. Sharma A, Lavie CJ, Borer JS, Vallakati A, Goel S, Lopez-Jimenez F, Arbab-Zadeh A, Mukherjee D, Lazar JM (2015) Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. Am J Cardiol 115(10):1428–1434

    PubMed  Google Scholar 

  16. Hamaguchi S, Tsuchihashi-Makaya M, Kinugawa S, Goto D, Yokota T, Goto K, Yamada S, Yokoshiki H, Takeshita A, Tsutsui H, Investigators J-C (2010) Body mass index is an independent predictor of long-term outcomes in patients hospitalized with heart failure in Japan. Circ J 74(12):2605–2611

    PubMed  Google Scholar 

  17. Sze S, Pellicori P, Kazmi S, Rigby A, Cleland JGF, Wong K, Clark AL (2018) Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: a comparison with body mass index. JACC Heart Fail 6(6):476–486

    PubMed  Google Scholar 

  18. Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W (2018) The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels 33(2):134–144

    PubMed  Google Scholar 

  19. Kinugasa Y, Kato M, Sugihara S, Hirai M, Yamada K, Yanagihara K, Yamamoto K (2013) Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J 77(3):705–711

    CAS  PubMed  Google Scholar 

  20. Jafri SH, Shi R, Mills G (2013) Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review. BMC Cancer 13:158

    PubMed  PubMed Central  Google Scholar 

  21. Tomita M, Ayabe T, Nakamura K (2018) The advanced lung cancer inflammation index is an independent prognostic factor after surgical resection in patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 26(2):288–292

    PubMed  Google Scholar 

  22. Park YH, Yi HG, Lee MH, Kim CS, Lim JH (2017) Prognostic value of the pretreatment advanced lung cancer inflammation index (ALI) in diffuse large B cell lymphoma patients treated with R-CHOP chemotherapy. Acta Haematol 137(2):76–85

    PubMed  Google Scholar 

  23. Feng JF, Huang Y, Chen QX (2014) A new inflammation index is useful for patients with esophageal squamous cell carcinoma. Onco Targets Ther 7:1811–1815

    PubMed  PubMed Central  Google Scholar 

  24. Jank BJ, Kadletz L, Schnoll J, Selzer E, Perisanidis C, Heiduschka G (2019) Prognostic value of advanced lung cancer inflammation index in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 276(5):1487–1492

    PubMed  Google Scholar 

  25. Shibutani M, Maeda K, Nagahara H, Fukuoka T, Matsutani S, Kimura K, Amano R, Hirakawa K, Ohira M (2019) The prognostic significance of the advanced lung cancer inflammation index in patients with unresectable metastatic colorectal cancer: a retrospective study. BMC Cancer 19(1):241

    PubMed  PubMed Central  Google Scholar 

  26. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285(26):1441–1446

    CAS  PubMed  Google Scholar 

  27. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Collaborators developing the Japanese equation for estimated GFR (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53(6):982–992

    CAS  PubMed  Google Scholar 

  28. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodriguez F, Fernandez G (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20(1):38–45

    CAS  PubMed  Google Scholar 

  29. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82(4):777–783

    CAS  PubMed  Google Scholar 

  30. Lin H, Zhang H, Lin Z, Li X, Kong X, Sun G (2016) Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Fail Rev 21(5):549–565

    CAS  PubMed  Google Scholar 

  31. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495

    PubMed  Google Scholar 

  32. Hartmann F, Packer M, Coats AJ, Fowler MB, Krum H, Mohacsi P, Rouleau JL, Tendera M, Castaigne A, Anker SD, Amann-Zalan I, Hoersch S, Katus HA (2004) Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: a substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Circulation 110(13):1780–1786

    CAS  PubMed  Google Scholar 

  33. Bettencourt P, Azevedo A, Pimenta J, Frioes F, Ferreira S, Ferreira A (2004) N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 110(15):2168–2174

    CAS  PubMed  Google Scholar 

  34. Kociol RD, Horton JR, Fonarow GC, Reyes EM, Shaw LK, O'Connor CM, Felker GM, Hernandez AF (2011) Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) linked to Medicare claims. Circ Heart Fail 4(5):628–636

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Agra Bermejo RM, Gonzalez Ferreiro R, Varela Roman A, Gomez Otero I, Kreidieh O, Conde Sabaris P, Rodriguez-Manero M, Moure Gonzalez M, Seoane Blanco A, Virgos Lamela A, Garcia Castelo A, Gonzalez Juanatey JR (2017) Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure. Int J Cardiol 230:108–114

    PubMed  Google Scholar 

  36. Honda Y, Nagai T, Iwakami N, Sugano Y, Honda S, Okada A, Asaumi Y, Aiba T, Noguchi T, Kusano K, Ogawa H, Yasuda S, Anzai T, NaDEFi (2016) Usefulness of geriatric nutritional risk index for assessing nutritional status and its prognostic impact in patients aged ≥65 years with acute heart failure. Am J Cardiol 118(4):550–555

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan

    Daichi Maeda, Yumiko Kanzaki, Kazushi Sakane, Takahide Ito, Koichi Sohmiya & Masaaki Hoshiga

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  1. Daichi Maeda
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  2. Yumiko Kanzaki
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  3. Kazushi Sakane
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Correspondence to Yumiko Kanzaki.

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Maeda, D., Kanzaki, Y., Sakane, K. et al. Prognostic impact of a novel index of nutrition and inflammation for patients with acute decompensated heart failure. Heart Vessels 35, 1201–1208 (2020). https://doi.org/10.1007/s00380-020-01590-4

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