title: Preoperative risk factors of malnutrition for cardiac surgery patients.
abstract: BACKGROUND
  Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients.
  
  
  METHODS
  The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models.
  
  
  RESULTS
  A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416-6.668,p= 0.007), valve pathology (OR: 1.825, CI95%: 1.182-2.819,p= 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995-8.389,p< 0.001) and body mass index (OR: 0.928, CI95%: 0.890-0.968,p< 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951-0.983,p< 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002-1.028,p= 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353-6.757,p= 0.007) and mobility (OR: 2.770, CI95%: 1.067-7.194,p= 0.036).
  
  
  CONCLUSIONS
  MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility and food intake.
authors.affiliation: Centre of Anaesthesiology, Intensive Care and Pain Treatment, Clinic of Anaesthesiology and Intensive Care, Vilnius University, Vilnius, Lithuania.
authors.forename: Donata
authors.initials: D
authors.lastname: Ringaitienė
authors.affiliation: Faculty of Medicine, Vilnius University.
authors.forename: Dalia
authors.initials: D
authors.lastname: Gineitytė
authors.affiliation: Haematology, Oncology and Transfusion Medicine Centre, Vilnius University.
authors.forename: Vaidas
authors.initials: V
authors.lastname: Vicka
authors.affiliation: Haematology, Oncology and Transfusion Medicine Centre, Vilnius University.
authors.forename: Tadas
authors.initials: T
authors.lastname: Žvirblis
authors.affiliation: Centre of Anaesthesiology, Intensive Care and Pain Treatment, Clinic of Anaesthesiology and Intensive Care, Vilnius University, Vilnius, Lithuania.
authors.forename: Jūratė
authors.initials: J
authors.lastname: Šipylaitė
authors.affiliation: Centre of Hepatology, Gastroenterology and Dietetics, Hepatology and Gastroenterology Department, Vilnius University.
authors.forename: Algimantas
authors.initials: A
authors.lastname: Irnius
authors.affiliation: Centre of Hepatology, Gastroenterology and Dietetics, Hepatology and Gastroenterology Department, Vilnius University.
authors.forename: Juozas
authors.initials: J
authors.lastname: Ivaškevičius
keywords: bioelectrical impedance analysis; cardiac surgery; malnutrition; phase angle; post-operative outcomes