title: Additional predictive value of nutritional status in the prognostic assessment of heart failure patients.
abstract: OBJECTIVE
  Nutritional status (NS) is not routinely assessed in HF. We sought to evaluate whether NS may be additive to a comprehensive pre-discharge evaluation based on a clinical score that includes BMI (MAGGIC) and on an index of functional capacity (six minute walking test, 6mWT) in HF patients.
  
  
  RESULTS
  The CONUT (Controlling Nutritional Status) score (including serum albumin level, total cholesterol and lymphocyte count) was computed in 466 consecutive patients (mean age 61 ± 11 years, NYHA class 2.6 ± 0.6, LVEF 34 ± 11%, BMI 27.2 ± 4.5) who had pre-discharge MAGGIC and 6MWT. The endpoint was all-cause mortality. Mild or moderate undernourishment was present in 54% of patients with no differences across BMI strata. The 12-month event rate was 7.7%. Deceased patients had a more compromised NS (CONUT 2.8 ± 1.5 vs 1.7 ± 1.3, p < 0.0001), and a more advanced HF (MAGGIC 28.2 ± 6.0 vs 22.0 ± 6.6, p < 0.0001; 6MWT 311.1 ± 102.2 vs. 408.9 ± 95.9 m, p < 0.0001). The 12-month mortality rate varied from 4% for well-nourished to 11% for undernourished patients (p = 0.008). At univariate analysis, the CONUT was predictive for all-cause mortality with a Hazard Ratio of 1.701 [95% CI 1.363-2.122], p < 0.0001. Multivariable analysis showed that the CONUT significantly added to the combination of MAGGIC and 6MWT and improved predictive discrimination and risk classification (c-index 0.82 [95% CI 0.75-0.88], integrated discrimination improvement 0.028 [95% CI 0.015-0.081]).
  
  
  CONCLUSIONS
  In HF patients assessment of NS, significantly improves prediction of 12-month mortality on top of the information provided by clinical evaluation and functional capacity and should be incorporated in the overall assessment of HF patients.
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy. Electronic address: mariateresa.larovere@fsm.it.
authors.forename: M T
authors.initials: MT
authors.lastname: La Rovere
authors.affiliation: Department of Biomedical Engineering, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Maestri
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Olmetti
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Paganini
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Riccardi
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Riccardi
authors.affiliation: Department of Biomedical Engineering, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: G D
authors.initials: GD
authors.lastname: Pinna
authors.affiliation: Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Traversi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016208:Databases, Factual; D003661:Decision Support Techniques; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D000070857:Walk Test
chemical_list: D015415:Biomarkers
keywords: 6-Minute walking test; CONUT score; Heart failure; MAGGIC score; Nutritional status; Prognosis; Undernourishment