Risk stratification based on nutritional screening on admission: Three-year clinical outcomes in hospitalized patients with acute heart failure syndrome.
Several blood tests are commonly used to assess nutritional status, including serum albumin levels (SAL) and lymphocyte counts (LC). The aim of this study is to investigate whether nutritional screening on admission can be used to determine risk levels for adverse clinical events in acute heart failure syndrome (AHFS) patients.



In 432 consecutive AHFS patients, we measured SAL and LC and prospectively followed the patients for their combined clinical events (all-cause death and re-hospitalization for heart failure) for three years from admission. The classification and regression tree (CART) tool identified the cut-off criteria for SAL and LC to differentiate among patients with different risks of clinical events as 3.5g/dl and 963/mm3, respectively.



The CART tool classified 15.5% patients as high risk, 15.7% as intermediate risk, and 68.8% as low risk. The CART for nutritional status (CART-NS) values were strongly correlated with combined clinical events [hazard ratio of 2.13 (low vs high risk), 95% confidence interval of 1.42-3.16, p<0.001], even after adjusting for plasma brain natriuretic peptide levels. The CART-NS analysis improved the specificity (89.5%) of predictions of clinical outcomes with the comparable sensitivity (36.3%) compared with the use of a single criterion (SAL <3.5g/dl: 70.2, 42.4% or LC <963/mm3: 73.4, 41.7%, respectively).



A substantial proportion of AHFS patients are at risk of malnutrition, and this risk is associated with poor clinical outcomes. We demonstrate that this algorithm for nutritional screening, even in emergency clinical settings, can determine risk levels for further adverse events in AHFS patients.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Masashi
M
Fujino
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: takahama@ncvc.go.jp.
Hiroyuki
H
Takahama
Office of Biostatistics and Data Management, Department of Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, Suita, Japan.
Toshimitsu
T
Hamasaki
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kenichi
K
Sekiguchi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Kengo
K
Kusano
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Toshihisa
T
Anzai
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Teruo
T
Noguchi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Yoichi
Y
Goto
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Masafumi
M
Kitakaze
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hiroyuki
H
Yokoyama
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Hisao
H
Ogawa
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Satoshi
S
Yasuda
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D018655:Lymphocyte Count; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012709:Serum Albumin
D012709:Serum Albumin
Acute heart failure; Albumin; Lymphocyte counts; Nutrition; Prognosis