title: Prognostic Value of the Nutritional Risk Index in Heart Transplant Recipients.
abstract: OBJECTIVE
  To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT).
  
  
  METHODS
  We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression.
  
  
  RESULTS
  Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI < 83.5), moderate nutritional risk (83.5 ≤ NRI < 97.5), and mild nutritional risk (97.5 ≤ NRI < 100) was 5%, 22%, and 10%, respectively. One year post-transplant mortality rates in these 4 categories were 18.2%, 25.3%, 7.9% and 10.2% (P < .001), respectively. The NRI was independently associated with a lower risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P < .001).
  
  
  CONCLUSIONS
  Malnourished patients have a higher risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention.
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain. Electronic address: eduardo.barge.caballero@sergas.es.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: García-López
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barge-Caballero
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Couto-Mallón
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Paniagua-Martín
authors.affiliation: Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Solla-Buceta
authors.affiliation: Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Velasco-Sierra
authors.affiliation: Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pita-Gutiérrez
authors.affiliation: Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Herrera-Noreña
authors.affiliation: Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000401:mortality; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000401:mortality
keywords: Desnutrición; Heart transplant; Malnourishment; Nutritional risk index; Outcomes; Pronóstico; Trasplante cardiaco; Índice de riesgo nutricional