Highlights
- •We investigated the relationship between prognostic nutritional index (PNI) combined with serum sodium level and all-cause mortality in heart failure (HF) patients and found that HF patients with both hyponatremia and worse nutrition status are at a higher risk of all-cause death and the combination of serum sodium level and PNI enhanced the predictive value for all-cause mortality in patients hospitalized for HF.
- •Our research included a total of 2882 patients and might be the clinical research with the biggest sample focusing on the nutrition state of HF patients in China.
- •The findings add new evidence of the association between the nutrition status and outcome in HF patients, thereby helping to standardize the management of nutrition in HF.
Abstract
Background and aims
Both malnutrition and hyponatremia (serum sodium <135 mmol/L) can be induced by the
impaired absorption function of the edematous intestinal wall caused by heart failure
(HF) and are prognostic factors of mortality in HF. However, little is known about
the interrelationship of nutritional status and hyponatremia in mortality risk prediction
in HF.
Methods and results
This study enrolled 2882 HF patients admitted to the HF care unit of Fuwai Hospital,
Beijing, China from 2008 to 2018; 71.3% were male and the mean age was 56.64 ± 15.96
years. Nutritional status was assessed by prognostic nutritional index (PNI), calculated
as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Lower PNI indicates worse nutritional status. Patients were divided into 8 groups
based on baseline PNI quartiles (Q1: <43.6, Q2: 43.6–48.55, Q3: 48.55–63.25, Q4: >63.25)
and sodium level (normal sodium and hyponatremia). After adjustment, patients in the
PNI Q1 associated with hyponatremia had a 2.12-fold higher risk of all-cause death
(95% confidence interval [CI]: 1.67–2.70) compared with those in the PNI Q4 with normal
sodium. A refinement in risk prediction was observed after adding PNI quartile and
serum sodium category to the original model (ΔC-statistic = 0.018, 95% CI: 0.007–0.025;
net re-classification index = 0.459, 95% CI: 0.371–0.548; integrated discrimination
improvement = 0.025, 95% CI: 0.018–0.032).
Conclusion
HF patients with both the lowest PNI quartile and hyponatremia are at higher risk
of all-cause mortality. The combination of PNI and serum sodium level enhanced the
predictive value for all-cause mortality in hospitalized HF patients.
Clinical trial registration
URL: ClinicalTrials.gov; Unique Identifier: NCT02664818.
Keywords
Abbreviations:
HF (heart failure), PNI (prognostic nutritional index), NT-proBNP (N-terminal pro-brain natriuretic peptide), LVEF (left ventricular ejection fraction), NYHA (New York Heart Association), CI (confidence interval), HR (hazard ratio), ALB (albumin), BMI (body mass index), CRE (creatinine), NRI (net reclassification improvement), IDI (integrated discrimination improvement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 13, 2022
Accepted:
April 4,
2022
Received in revised form:
April 2,
2022
Received:
January 10,
2022
Handling Editor: A. SianiIdentification
Copyright
© 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
