【論文摘要】Comparison of the In-hospital Outcomes and Clinical Profiles among Heart Failure Patients with Good and Poor Nutritional Status in a Level III Tertiary Hospital

Mary Lauren Europa ； Julie Miralles ； Marjan Heidari ； Grethel Dimalala

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 228-228

https://doi.org/10.6907/SCJ.201909/SP_1(2).0189

摘要

Background/Synopsis: Previous studies have shown the correlation of nutritional status to clinical profiles and outcomes in heart failure, and early nutritional intervention may be beneficial. The Prognostic Nutritional Index (PNI), derived from the serum albumin and total lymphocyte count, may be used as an objective surrogate for a patient's nutritional status. Objectives/Purpose: To compare the clinical outcomes of patients with CHF with high and low PNI, and describe the clinical profiles for each subgroup. Methods/Results: Methods: Demographic and clinical data of patients with CHF were obtained via chart review. PNI was calculated, and patients were grouped into high PNI (PNI ＞ 45, good nutritional status), and low PNI (PNI ＜45 poor nutritional status). Data analysis was performed using independent T-test for quantitative variables and Fischer's exact test for qualitative variables. The level of significance was set at 5%. Results and Analysis: A total of 231 patients were enrolled. Patients with poor nutritional status (lower PNI)were more likely to have an inhospital mortality and prolonged hospital stay (p = 0.02 and p = 0.025, respectively), and less likely to be discharged improved (p = 0.04). Furthermore, these patients tended to have an ICU stay during their confinement. These same patients were noted to be more likely to be older, more likely to be underweight or even have normal weight, and less likely to be overweight. The reverse is true for patients with good nutritional status (higher PNI). Conclusion: Lower PNI levels were associated with increased inhospital mortality and prolonged hospital stay, while higher PNI levels are associated with improvement on discharge. Thus, PNI may be a useful prognostic factor for clinical outcomes of patients with CHF. Cardiac cachexia tends to be underdiagnosed and often unrecognized until late stages. Since serum albumin and CBC are reasonable ancillaries to request for, the findings of this study may help clinicians in the early recognition of malnutrition, wherein patients presenting with the aforementioned clinical profiles may be more closely observed with respect to their nutritional status. Ultimately, this may contribute to preventing or delaying the onset of cardiac cachexia. Furthermore, this research aims to add to the growing number of data regarding the use of PNI in cardiovascular disease, especially in the Filipino setting. To the best of our knowledge, this is the first study in the Philippines regarding the use of PNI in heart failure patients.