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Nutritional status and risk of all-cause mortality in patients undergoing transcatheter aortic valve replacement assessment using the geriatric nutritional risk index and the controlling nutritional status score

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Abstract

Background

Nutritional status, a key marker of patient frailty, is an important prognostic factor after transcatheter aortic valve replacement (TAVR). Few investigations have evaluated the clinical usefulness of nutritional assessment tools for predicting the risk of mortality following TAVR.

Methods

A total of 412 patients with symptomatic severe AS who underwent TAVR between March 2010 and August 2017 were stratified into subgroups by their Geriatric Nutritional Risk Index [GNRI, low ≤ 98 vs. high > 98 (better nutritional status)] and Controlling Nutritional Status (CONUT) score [low ≤ 3 vs. high ≥ 4; (poorer nutritional status)]. The primary study outcome was all-cause mortality at 1 year.

Results

Patients with low GNRI score showed a significantly higher 1-year mortality rate as compared to those with high GNRI score (13.0% vs. 3.2%, respectively; P = 0.001). Similarly, patients with high CONUT score had a significantly higher rate of 1-year mortality than those with low CONUT score (15.7% vs. 6.2%, respectively; P = 0.005). However, in multivariable Cox proportional-hazards models, low GNRI was the only independent predictor of mortality (adjusted hazard ratio, 3.77; 95% confidence interval 1.54–9.20; P = 0.004). Overall, integration of GNRI into conventional risk models of STS score or logistic EuroSCORE resulted in improved predictive value for mortality measured by the net reclassification improvement and the integrated discrimination improvement.

Conclusions

In patients undergoing TAVR, low GNRI (but not high CONUT score) was independently associated with a higher risk of 1-year mortality. Further research is required to determine whether nutritional screening and management can improve clinical outcomes in patients undergoing TAVR.

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Abbreviations

AS:

Aortic stenosis

BMI:

Body-mass index

CONUT:

Controlling nutritional status

CT:

Computed tomography

EuroSCORE:

Logistic European System for cardiac operative risk evaluation

GNRI:

Geriatric nutritional risk index

STS:

Society of thoracic surgeons

TAVR:

Transcatheter aortic valve replacement

VARC:

The valve academic research consortium

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Acknowledgements

This work was partly supported by the Cardiovascular Research Foundation, Seoul, Korea. The sponsors played no role in this study. There was no industry involvement in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.

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Author notes

  1. Kyusup Lee and Jung-Min Ahn contributed equally to this article.

Authors and Affiliations

  1. Department of Cardiology, Daejeon St Mary’s Hospital, The Catholic University of Korea, Daejeon, South Korea

    Kyusup Lee

  2. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jung-Min Ahn, Do-Yoon Kang, Euihong Ko, Osung Kwon, Pil Hyung Lee, Seung-Whan Lee, Dae-Hee Kim, Duk-Woo Park & Seung-Jung Park

  3. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Ho Jin Kim, Joon Bum Kim & Suk Jung Choo

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  1. Kyusup Lee
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Correspondence to Duk-Woo Park.

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Lee, K., Ahn, JM., Kang, DY. et al. Nutritional status and risk of all-cause mortality in patients undergoing transcatheter aortic valve replacement assessment using the geriatric nutritional risk index and the controlling nutritional status score. Clin Res Cardiol 109, 161–171 (2020). https://doi.org/10.1007/s00392-019-01497-9

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