[Body mass index and albuminemia in patients under mechanical circulatory assistance before cardiac transplantation].
OBJECTIVE
To evaluate the prognostic influence of peri-implantation nutritional status of patients under mechanical circulatory assist (MCA) prior to cardiac transplantation (CT).


METHODS
Retrospective analysis of patients with cardiogenic shock included from June 1997 to December 2002.


METHODS
Evaluation at MCA's implantation, at day (D) 30 and at CT or patient's death (D) of body mass index (BMI=body weight (kg)/size (m(2)), albuminemia (Alb g/l), expressed as median values (med) and range (min-max). Odds ratio (OR) and CI 95%) were calculated. A multivariate analysis was performed to determine variables related to D or CT success.


RESULTS
Thirty-four patients (30 men), median age 40.5 years (10-63), were included. MCA types were cardiac pumps (N=3); pneumatic (N=18) or electric (N=5) ventricular assist devices and artificial heart (N=8). Global mortality was 56% (19 over 34 patients) and at implantation in the global population (N=34) BMI was 19.4 (9.3-28.1) and Alb 24.6 g/l (15-37.5). At MCA's implantation and D30 respectively, 38 and 42% of the patients had a severe hypoAlb (Alb<30 g/l) and a BMI<19 attesting of a seriously deteriorated nutritional status. No significant statistical difference was observed on median BMI of transplanted patients T (N=15) and expired patients D (N=19). Alb was significantly different (p<10(-4)) between T and D patients: median Alb: 30 g/l (20-37.5) in T patients, 20 g/l (15-31) in D patients. HypoAlb<21 g/l was an independent prognostic factor of death (p=0.004; OR: 0.541; IC95% : 0.36-0.82) and Alb>33 g/l an independent prognostic factor of CT success (p=0.003; OR:1.38; IC95% : 1.12-1.71).


CONCLUSIONS
These results seem to demonstrate that at MCA implantation, a seriously deteriorated albuminemia level (<30 g/l) negatively impacts patients overall survival after CT.
Desseigne
P P
PP
Service d'anesthésie-réanimation chirurgicale cardiothoracique et vasculaire, hôpital Laënnec, CHU de Nantes, 44093 Nantes cedex, France. pascal.desseigne@chu-nantes.fr
Treilhaud
M
M
Bérard
L
L
Delile
L
L
Fournet
X
X
Bizouarn
P
P
Rigal
J C
JC
Le Teurnier
Y
Y
Blanloeil
Y
Y
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D003643:Death; D005260:Female; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D011379:Prognosis; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D012770:Shock, Cardiogenic / Q000503:physiopathology; D016896:Treatment Outcome
D012709:Serum Albumin