Nutritional markers and prognosis in cardiac cachexia.
BACKGROUND
Cachexia frequently complicates chronic heart failure (CHF) and predicts an ominous prognosis. Hormonal and inflammatory environment differ between cachectic and non-cachectic patients. Nutritional markers of cardiac cachexia and prognostic predictors in this context are not completely understood.


OBJECTIVE
To study biochemical markers of nutritional status in cardiac cachexia and to investigate variables associated with worse prognosis.


METHODS
A total of 94 ambulatory patients--38 cachectics and 56 non-cachectics--were recruited. Cardiac cachexia was defined as a weight loss of ≥ 7.5%. An anthropometric evaluation was performed in all patients and blood was collected for several laboratory determinations: haemoglobin, lymphocytes, albumin, transferrin, pre-albumin, cholesterol and triglycerides. Patients were included in a prospective cohort study.


RESULTS
Cachectics had lower albumin and pre-albumin levels. They also had lower haemoglobin, lymphocytes and triglycerides. Levels of high-sensitivity C-reactive protein, and catabolic hormones were higher in the cachectic group. Low pre-albumin was the only nutritional marker independently associated with cardiac cachexia. (OR = 1.08, CI: 1.01-1.17). During a follow-up of 16.2 ± 5.2 months, 15 (39.4%) cachectic patients and 6 (10.7%) non-cachectics died. In the cachectic group, lower cholesterol was independently associated with worse outcome (HR = 1.32, CI: 1.11-1.57).


CONCLUSIONS
Pre-albumin seems to be the best laboratory marker of undernutrition in CHF. Low cholesterol independently associates with worse outcome in cardiac cachexia.
Araújo
José Paulo
JP
Heart Failure Clinic, Serviço de Medicina Interna, Hospital S João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Portugal. pauloaraujo@iol.pt
Lourenço
Patrícia
P
Rocha-Gonçalves
Francisco
F
Ferreira
António
A
Bettencourt
Paulo
P
D000368:Aged; D002100:Cachexia / Q000209:etiology* / Q000401:mortality; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies