1
|
Sun S, Wang Y, Pang S, Wu X. Combination of the glycated hemoglobin levels and prognostic nutritional index as a prognostic marker in patients with acute coronary syndrome and type 2 diabetes mellitus. Lipids Health Dis 2024; 23:12. [PMID: 38212760 PMCID: PMC10782571 DOI: 10.1186/s12944-023-01992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Increased susceptibility to malnutrition and inadequate glycemic control are frequently observed in diabetic patients with coronary artery disease. The assessment of malnutrition is performed using the prognosis nutritional index (PNI). The inadequate glycemic control is measured using glycated hemoglobin (HbA1c). However, the combined effect of PNI and HbA1c on the prognosis in diabetic patients with coronary artery disease remains unknown. METHODS A study was conducted at Beijing Anzhen Hospital and included 2,005 patients diagnosed with type 2 diabetes mellitus (T2DM) accompanied by acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) from September 2021 to January 2022. Based on the median PNI and HbA1c, we categorized the patients into four groups including high (H)-PNI/low (L)-HbA1c, H-PNI/H-HbA1c, L-PNI/L-HbA1c, and L-PNI/H-HbA1c. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome, including all-cause mortality, nonfatal myocardial infarction (MI), and nonfatal strokes. RESULTS Throughout a median follow-up of 16.3 months, 73 patients had MACCE, which comprised 36 cases of all-cause mortality. In comparison to the H-PNI, the L-PNI showed an obvious rise in MACCE and all-cause mortality (log-rank P = 0.048 and 0.021, respectively) among the H-HbA1c group. Compared to the other groups, the L-PNI/H-HbA1c group exhibited the greatest risk of MACCE (adjusted hazard ratio [aHR]: 2.50, 95% confidence interval [CI] 1.20-5.23, P = 0.014) and all-cause mortality (HR: 3.20, 95% CI 1.04-9.82, P = 0.042). With the addition of PNI, MACCE and all-cause mortality prediction models performed significantly better in patients with ACS and T2DM after PCI, particularly in those with H-HbA1c levels. CONCLUSIONS The combination of L-PNI and H-HbA1c is a prognostic marker for MACCE and all-cause mortality in patients diagnosed with ACS and T2DM who underwent PCI. The PNI can serve as an assessment tool of malnutrition in patients with ACS and T2DM accompanied by H-HbA1c who underwent PCI. Therefore, monitoring the long-term change of the PNI deserves attention in clinical practice.
Collapse
Affiliation(s)
- Shuaifeng Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shuo Pang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
2
|
Sudo M, Shamekhi J, Aksoy A, Al-Kassou B, Tanaka T, Silaschi M, Weber M, Nickenig G, Zimmer S. A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2024; 113:58-67. [PMID: 37178161 PMCID: PMC10808226 DOI: 10.1007/s00392-023-02220-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. METHODS A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. RESULTS Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05-1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22-3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). CONCLUSION Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR.
Collapse
Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| |
Collapse
|
3
|
Shao X, Zhang H, Xu Z, Lang X. Prognostic value of TCBI for short-term outcomes in ATAD patients undergoing surgery. Gen Thorac Cardiovasc Surg 2023; 71:685-691. [PMID: 37338794 DOI: 10.1007/s11748-023-01949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Nutritional status has been reported to be associated with the prognosis of cardiovascular diseases. The study aimed to investigate the prognostic value of Triglycerides-total Cholesterol-Body weight-Index (TCBI) for short-term mortality in acute type A aortic dissection (ATAD) patients undergoing surgery. METHODS AND RESULTS Totally, the data of 290 ATAD patients undergone surgery were, retrospectively, analyzed. After logistic regression analysis, TCBI was identified as an independent predictor of short-term mortality in ATAD surgery. The development of receive operating characteristic (ROC) curve demonstrated that TCBI (AUC = 0.745, P < 0.001) could provide well prognostic value for short-term mortality. Accordingly, the optimal cut-off value was identified as 883.5 and patients were divided into high TCBI (> 883.5) and low TCBI (≤ 883.5) groups. Furthermore, Kaplan-Meier analysis illustrated that short-term mortality increased significantly in the low TCBI group than in the high TCBI group (P < 0.0001). In addition, the incidence of postoperative renal failure was also elevated in the low TCBI group (P = 0.0011). CONCLUSION Malnutrition by preoperative TCBI presented strong prognostic value for patients following ATAD surgery. And TCBI could be applied for risk stratification and therapeutic strategy-making in ATAD.
Collapse
Affiliation(s)
- Xin Shao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xilong Lang
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| |
Collapse
|
4
|
Abe H, Miyazaki T, Tomaru M, Nobushima Y, Ajima T, Hirabayashi K, Ishiwata S, Kakihara M, Maki M, Shimai R, Aikawa T, Isogai H, Ozaki D, Yasuda Y, Odagiri F, Takamura K, Hiki M, Iwata H, Yokoyama K, Tokano T, Minamino T. Poor Nutritional Status during Recovery from Acute Myocardial Infarction in Patients without an Early Nutritional Intervention Predicts a Poor Prognosis: A Single-Center Retrospective Study. Nutrients 2023; 15:4748. [PMID: 38004141 PMCID: PMC10674636 DOI: 10.3390/nu15224748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Whether malnutrition during the early phase of recovery from acute myocardial infarction (AMI) could be a predictor of mortality or morbidity has not been ascertained. We examined 289 AMI patients. All-cause mortality and composite endpoints (all-cause mortality, nonfatal stroke, nonfatal acute coronary syndrome, and hospitalization for acute decompensated heart failure) during the follow-up duration (median 39 months) were evaluated. There were 108 (37.8%) malnourished patients with GNRIs of less than 98 on arrival; however, malnourished patients significantly decreased to 91 (31.4%) during the convalescence period (p < 0.01). The incidence rates of mortality and primary composite endpoints were significantly higher in the malnourished group than in the well-nourished group both on arrival and during the convalescence period (All p < 0.05). Nutrition guidance significantly improved GNRI in a group of patients who were undernourished (94.7 vs. 91.0, p < 0.01). Malnourished patients on admission who received nutritional guidance showed similar all-cause mortality with well-nourished patients, whereas malnourished patients without receiving nutritional guidance demonstrated significantly worse compared to the others (p = 0.03). The assessment of GNRI during the convalescence period is a useful risk predictor for patients with AMI. Nutritional guidance may improve the prognoses of patients with poor nutritional status.
Collapse
Affiliation(s)
- Hiroshi Abe
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Masato Tomaru
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Yuka Nobushima
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tomohi Ajima
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Koji Hirabayashi
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Sayaki Ishiwata
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Midori Kakihara
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Masaaki Maki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Ryosuke Shimai
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tadao Aikawa
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Dai Ozaki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Yuki Yasuda
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Fuminori Odagiri
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Kazuhisa Takamura
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
| | - Ken Yokoyama
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo 100-0004, Japan
| |
Collapse
|
5
|
Liang L, Zhao X, Huang L, Tian P, Huang B, Feng J, Zhou P, Wang J, Zhang J, Zhang Y. Prevalence and prognostic importance of malnutrition, as assessed by four different scoring systems, in elder patients with heart failure. Nutr Metab Cardiovasc Dis 2023; 33:978-986. [PMID: 36710105 DOI: 10.1016/j.numecd.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS The lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems. METHODS AND RESULTS Consecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903-1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001). CONCLUSION Malnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk. CLINICAL TRIAL REGISTRATION URL: ClinicalTrials.gov; Unique Identifier: NCT02664818.
Collapse
Affiliation(s)
- Lin Liang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Liyan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Boping Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jiayu Feng
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Ping Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jinxi Wang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China; Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, No.167 Beilishi Road, 10037, Beijing, China.
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
| |
Collapse
|
6
|
Shi Y, Wang X, Yu C, Zhou W, Wang T, Zhu L, Bao H, Cheng X. Association of a novel nutritional index with stroke in Chinese population with hypertension: Insight from the China H-type hypertension registry study. Front Nutr 2023; 10:997180. [PMID: 37113292 PMCID: PMC10126229 DOI: 10.3389/fnut.2023.997180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Objective The abbreviated TCB index (TCBI) is a novel indicator of nutritional status, calculated by multiplying the serum values of triglycerides (TG), total serum cholesterol (TC), and body weight. The research on the relationship between this index and stroke is limited. We aimed to investigate the association between TCBI and stroke in Chinese hypertensive patients. Methods and results A total of 13,358 adults with hypertension from the China H-type Hypertension Registry Study were enrolled. The TCBI was calculated as TG (mg/dL) * TC (mg/dL) * body weight (kg)/1,000. The primary outcome was an incidence of stroke. Multivariable adjusted models revealed an inverse association between TCBI and the prevalence of stroke. In the fully adjusted model, the results showed that the prevalence of stroke decreased by 13% (OR, 0.87; 95% CI, 0.78-0.98, p = 0.018) per SD increment of LgTCBI. When TCBI was assessed as a categorical variable, compared with those in group Q4 (TCBI ≥ 2,399), the participants in group Q3 (TCBI ≥ 1,476 and <2,399), group Q2 (TCBI ≥ 920 and <1,476), and group Q1 (TCBI < 920) had increases in stroke prevalence of 42% (OR, 1.42; 95% CI, 1.13-1.80; p-value = 0.003), 38% (OR, 1.38; 95% CI, 1.07-1.80; p-value = 0.014), and 68% (OR, 1.68; 95% CI, 1.24-2.27; p-value = 0.001), respectively. Subgroup analysis showed an interaction between age and TCBI and stroke (age < 60 years OR, 0.69; 95% CI, 0.58-0.83; vs. age ≥ 60 years OR, 0.95; 95% CI, 0.84-1.07; P for interaction = 0.001). Conclusion We found an independent negative association between TCBI and the prevalence of stroke, especially in hypertensive patients aged < 60 years.
Collapse
Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Xingjiu Wang
- Wuyuan Ziyang County Health Center, Shangrao, Jiangxi, China
| | - Chao Yu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- *Correspondence: Huihui Bao,
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Xiaoshu Cheng,
| |
Collapse
|
7
|
Low alanine aminotransferase levels are independently associated with mortality risk in patients with atrial fibrillation. Sci Rep 2022; 12:12183. [PMID: 35842444 PMCID: PMC9288442 DOI: 10.1038/s41598-022-16435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
Extremely low alanine aminotransferase (ALT) may reflect aging, frailty, sarcopenia, and malnutrition in several cardiovascular diseases, but the association between low ALT and patient characteristics, cardiovascular and all-cause mortality is not well investigated in the population with atrial fibrillation. We conducted a post hoc analysis of a prospective, observational multicenter study. Patients with nonvalvular AF in the SAKURA AF Registry (n = 3156) were classified into 3 tertiles according to baseline ALT: first (ALT ≤ 15 U/L, n = 1098), second (15 < ALT < 23 U/L, n = 1055), and third (ALT ≥ 23 U/L, n = 1003). The first tertile had an older age; lower body mass index (BMI); higher prevalence of heart failure; and lower hemoglobin, total cholesterol, and triglycerides (all P < 0.05). During median 39.2 months follow-up, the first tertile had significantly higher incidences of cardiovascular and all-cause mortality (log-rank P < 0.001). Lower ALT was significantly associated with the incidence of cardiovascular and all-cause mortality, even after adjusting for clinically relevant factors (P < 0.05). Low ALT may reflect aging, sarcopenia, and malnutrition and be independently associated with a high risk of all-cause mortality in patients with AF.
Collapse
|
8
|
Zhang G, Pan Y, Zhang R, Wang M, Meng X, Li Z, Li H, Wang Y, Zhao X, Wang Y, Liu G. A novel nutritional index and adverse outcomes in ischemic stroke: Results from the third China National Stroke Registry. Nutr Metab Cardiovasc Dis 2022; 32:1477-1484. [PMID: 35351344 DOI: 10.1016/j.numecd.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Few studies have applied the triglyceride, cholesterol, body weight index (TCBI) in acute ischemic stroke (AIS). We investigated the association between the TCBI and adverse clinical outcomes in patients with AIS. METHODS AND RESULTS Based on the Third China National Stroke Registry (CNSR-III) data from August 2015 to March 2018, we evaluated the nutritional status of patients with AIS using the TCBI. Patients were categorized according to quartile levels of the TCBI. The main outcomes were poor functional outcomes and recurrent stroke at 1-year and secondary outcomes were adverse outcomes at 3 and 6 months after stroke onset. Poor functional outcomes consisted of all-cause mortality and major disabilities. Multivariate analyses with logistic or Cox regression analysis and restricted cubic splines determined the association between the TCBI and adverse outcomes. We included 9708 patients. At the 1-year follow-up, 1323 patients (13.6%) had died or experienced major disability. The adjusted odds ratios/hazard ratios and 95% confidence intervals of the lowest quartile at 1-year were 1.47 (1.22-1.78) for poor functional outcomes, 1.46 (1.18-1.81) for major disability, and 1.34 (0.94-1.86) for all-cause mortality. Kaplan-Meier analysis demonstrated an inverse relationship between all-cause mortality and the TCBI (log-rank p < 0.05). An approximately L-shaped relationship between TCBI levels and poor functional outcomes and major disability was observed at 1-year. CONCLUSION The novel TCBI was associated with short- and long-term adverse outcomes in AIS. Thus, it may be useful for predicting adverse outcomes in patients with AIS.
Collapse
Affiliation(s)
- Guitao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, 2019RU018, Beijing, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| |
Collapse
|
9
|
Fan H, Huang Y, Zhang H, Feng X, Yuan Z, Zhou J. Association of Four Nutritional Scores With All-Cause and Cardiovascular Mortality in the General Population. Front Nutr 2022; 9:846659. [PMID: 35433793 PMCID: PMC9006821 DOI: 10.3389/fnut.2022.846659] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Malnutrition is a well known risk factor for adverse outcomes in patients with cancer, cardiovascular disease (CVD) and chronic kidney disease, but epidemiological evidence on its relationship with the long-term risk of all-cause mortality and cardiovascular death is limited. Methods A total of 20,116 adults from the United States National Health and Nutrition Examination Survey 2007–2014 were enrolled. The Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI) were calculated at baseline. Cox regression and the Kaplan–Meier analysis were conducted when participants were divided into three groups according to the tertiles of objective nutritional scores. Restricted cubic spline was performed to further explore the shape of the relationship between all-cause mortality, cardiovascular death, and nutritional scores. In addition, the area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were conducted to assess which nutritional scores have the greatest predictive value for all-cause death and cardiovascular death in the general population. Results The cumulative incidence of all-cause death and cardiovascular death was significantly higher in participants with a higher CONUT score, lower GNRI, and lower PNI. TCBI showed the worst performance on grading and risk assessment. After adjusting confounding factors, the lowest PNI and GNRI tertile and highest COUNT score were independently and significantly associated with increased risk of all-cause death (all P < 0.01) and cardiovascular death (all P < 0.05) analyzed by a multivariate Cox regression model. An L-shaped association between the HR (hazard ratio) of all-cause mortality and nutritional scores (GNRI, PNI and TCBI) was observed in the overall populations. In addition, the PNI had the highest predictive value for all-cause mortality [AUC: 0.684, 95% confidence interval (CI): 0.667–0.701] and cardiovascular death (AUC: 0.710, 95% CI: 0.672–0.749) in the general population compared with other nutritional scores. Conclusion The poorer the nutritional status of the general population, the higher the all-cause mortality and cardiovascular mortality. The PNI score may provide more useful predictive values than other nutritional scores.
Collapse
Affiliation(s)
- Heze Fan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Yuzhi Huang
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Haoxuan Zhang
- Department of Bioengineering, Southwest Jiaotong University, Chengdu, China
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Xueying Feng
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
- *Correspondence: Zuyi Yuan
| | - Juan Zhou
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
- Juan Zhou
| |
Collapse
|
10
|
Wang C, Qing Y, Chen W, Li G. A novel nutritional index as a predictor of mortality in dilated cardiomyopathy: a retrospective study. PeerJ 2022; 10:e12704. [PMID: 35111392 PMCID: PMC8783563 DOI: 10.7717/peerj.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research has associated nutritional status with the prognosis of cardiovascular diseases. This study aimed to investigate the prognostic value of a novel nutritional index, triglycerides × total cholesterol × body weight index (TCBI), in patients with dilated cardiomyopathy (DCM). METHODS This retrospective cohort study enrolled 445 patients with DCM. The median follow-up period was 2.8 years, and the primary endpoint was all-cause death. RESULTS During follow-up, the all-cause mortality was observed in 135 out of 445 patients (30.3%). In Kaplan-Meier survival analysis, the third TCBI tertile had a lower mortality risk (T3 vs. T2 vs. T1: 16.9% vs. 35.1% vs. 38.9%; log-rank P < 0.001). In the multivariable Cox regression analysis, patients in the third tertile were associated with a decreased mortality, whereas there was no significant difference between the T2 and T1 groups. Moreover, TCBI could significantly improve risk stratification (continuous net reclassification improvement and integrated discrimination improvement) over the Geriatric Nutritional Risk Index (GNRI) and N-terminal pro-brain natriuretic peptide (NT-proBNP). CONCLUSIONS TCBI is independently associated with long-term survival in patients with DCM. Combination of TCBI and other biomarkers, such as GNRI and NT-proBNP, can significantly improve prognostic prediction. Further studies with larger sample size are required to validate our results.
Collapse
Affiliation(s)
- Can Wang
- Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yali Qing
- Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wuxian Chen
- Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Gaoye Li
- Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
11
|
Łukaszyk E, Bień-Barkowska K, Bień B. Identification of Mortality Risks in the Advancement of Old Age: Application of Proportional Hazard Models Based on the Stepwise Variable Selection and the Bayesian Model Averaging Approach. Nutrients 2021; 13:nu13041098. [PMID: 33801694 PMCID: PMC8066062 DOI: 10.3390/nu13041098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Identifying factors that affect mortality requires a robust statistical approach. This study’s objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person’s mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.
Collapse
Affiliation(s)
- Ewelina Łukaszyk
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
- Correspondence: ; Tel.: +48-47-710-40-23
| | - Katarzyna Bień-Barkowska
- Institute of Econometrics, Warsaw School of Economics, Madalińskiego 6/8, 02-513 Warsaw, Poland;
| | - Barbara Bień
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
| |
Collapse
|