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Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure
Abstract Background and aims Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional...
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| Published in: | Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2017-05, Vol.27 (5), p.430-437 |
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| creator | Sargento, L Vicente Simões, A Rodrigues, J Longo, S Lousada, N Palma dos Reis, R |
| description | Abstract Background and aims Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model. Methods and results A total of 143 outpatients with HFrEF, aged >65 years, a LVEF |
| doi_str_mv | 10.1016/j.numecd.2017.02.003 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1891889225</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0939475317300388</els_id><sourcerecordid>1891889225</sourcerecordid><originalsourceid>FETCH-LOGICAL-c417t-a227dbb4d2a6d9f575d54147deb703334384b2ba7f9918f02258b5f9f622e1a13</originalsourceid><addsrcrecordid>eNqFks9u1DAQxi0EokvhDRDykUuC_2WdXJBQBQWpEgfgbDn2RPXWiRePs7APwHvj1bZIcOE0h_l-M_rmG0JectZyxrdvdu2yzuB8KxjXLRMtY_IR2fBuYI3UYnhMNmyQQ6N0Jy_IM8RdFWgm1VNyIXole6nlhvy6hhxsycHRZa2lhLTYSHPAOxoWDz-pRWr_6tnFU1zzIRwehBYREGdYCi0pxQpSLHaMQNNa9raE2kH6I5RbikcsKdZtt2BzoZMNcc3wnDyZbER4cV8vybcP779efWxuPl9_unp30zjFdWmsENqPo_LCbv0wdbrzneJKexirMSmrKTWK0eppGHg_MSG6fuymYdoKAdxyeUlen-fuc_q-AhYzB3QQo10grWh4X7l-qFyVqrPU5YSYYTL7HGabj4YzcwrA7Mw5AHMKwDBh6n0r9up-wzrO4P9ADxevgrdnAVSfhwDZoKv3ceBDBleMT-F_G_4d4GJYgrPxDo6Au7TmmlL1YrAC5svpCU4_wLWseN_L30NpsNA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1891889225</pqid></control><display><type>article</type><title>Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure</title><source>ScienceDirect Journals</source><creator>Sargento, L ; Vicente Simões, A ; Rodrigues, J ; Longo, S ; Lousada, N ; Palma dos Reis, R</creator><creatorcontrib>Sargento, L ; Vicente Simões, A ; Rodrigues, J ; Longo, S ; Lousada, N ; Palma dos Reis, R</creatorcontrib><description>Abstract Background and aims Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model. Methods and results A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90–0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15–0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9. Conclusion The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model.</description><identifier>ISSN: 0939-4753</identifier><identifier>EISSN: 1590-3729</identifier><identifier>DOI: 10.1016/j.numecd.2017.02.003</identifier><identifier>PMID: 28438373</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Aged, 80 and over ; Area Under Curve ; Biomarkers - blood ; Body Weight ; Cardiovascular ; Chi-Square Distribution ; Decision Support Techniques ; Female ; Geriatric Assessment - methods ; Geriatric nutritional risk index ; Heart Failure, Systolic - diagnosis ; Heart Failure, Systolic - mortality ; Heart Failure, Systolic - physiopathology ; Humans ; Male ; Malnutrition - diagnosis ; Malnutrition - mortality ; Malnutrition - physiopathology ; Models, Biological ; Multivariate Analysis ; Nutrition Assessment ; Nutritional assessment ; Nutritional Status ; Outpatients ; Portugal ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; ROC Curve ; Serum Albumin - analysis ; Serum Albumin, Human ; Stroke Volume ; Systolic heart failure ; Time Factors ; Ventricular Function, Left</subject><ispartof>Nutrition, metabolism, and cardiovascular diseases, 2017-05, Vol.27 (5), p.430-437</ispartof><rights>The Italian Society of Diabetology, 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</rights><rights>2017 The Italian Society of Diabetology, 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</rights><rights>Copyright © 2017 The Italian Society of Diabetology, 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.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-a227dbb4d2a6d9f575d54147deb703334384b2ba7f9918f02258b5f9f622e1a13</citedby><cites>FETCH-LOGICAL-c417t-a227dbb4d2a6d9f575d54147deb703334384b2ba7f9918f02258b5f9f622e1a13</cites><orcidid>0000-0002-5792-6723</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28438373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sargento, L</creatorcontrib><creatorcontrib>Vicente Simões, A</creatorcontrib><creatorcontrib>Rodrigues, J</creatorcontrib><creatorcontrib>Longo, S</creatorcontrib><creatorcontrib>Lousada, N</creatorcontrib><creatorcontrib>Palma dos Reis, R</creatorcontrib><title>Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure</title><title>Nutrition, metabolism, and cardiovascular diseases</title><addtitle>Nutr Metab Cardiovasc Dis</addtitle><description>Abstract Background and aims Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model. Methods and results A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90–0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15–0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9. Conclusion The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Biomarkers - blood</subject><subject>Body Weight</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Decision Support Techniques</subject><subject>Female</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatric nutritional risk index</subject><subject>Heart Failure, Systolic - diagnosis</subject><subject>Heart Failure, Systolic - mortality</subject><subject>Heart Failure, Systolic - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Malnutrition - diagnosis</subject><subject>Malnutrition - mortality</subject><subject>Malnutrition - physiopathology</subject><subject>Models, Biological</subject><subject>Multivariate Analysis</subject><subject>Nutrition Assessment</subject><subject>Nutritional assessment</subject><subject>Nutritional Status</subject><subject>Outpatients</subject><subject>Portugal</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Serum Albumin - analysis</subject><subject>Serum Albumin, Human</subject><subject>Stroke Volume</subject><subject>Systolic heart failure</subject><subject>Time Factors</subject><subject>Ventricular Function, Left</subject><issn>0939-4753</issn><issn>1590-3729</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqFks9u1DAQxi0EokvhDRDykUuC_2WdXJBQBQWpEgfgbDn2RPXWiRePs7APwHvj1bZIcOE0h_l-M_rmG0JectZyxrdvdu2yzuB8KxjXLRMtY_IR2fBuYI3UYnhMNmyQQ6N0Jy_IM8RdFWgm1VNyIXole6nlhvy6hhxsycHRZa2lhLTYSHPAOxoWDz-pRWr_6tnFU1zzIRwehBYREGdYCi0pxQpSLHaMQNNa9raE2kH6I5RbikcsKdZtt2BzoZMNcc3wnDyZbER4cV8vybcP779efWxuPl9_unp30zjFdWmsENqPo_LCbv0wdbrzneJKexirMSmrKTWK0eppGHg_MSG6fuymYdoKAdxyeUlen-fuc_q-AhYzB3QQo10grWh4X7l-qFyVqrPU5YSYYTL7HGabj4YzcwrA7Mw5AHMKwDBh6n0r9up-wzrO4P9ADxevgrdnAVSfhwDZoKv3ceBDBleMT-F_G_4d4GJYgrPxDo6Au7TmmlL1YrAC5svpCU4_wLWseN_L30NpsNA</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Sargento, L</creator><creator>Vicente Simões, A</creator><creator>Rodrigues, J</creator><creator>Longo, S</creator><creator>Lousada, N</creator><creator>Palma dos Reis, R</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5792-6723</orcidid></search><sort><creationdate>20170501</creationdate><title>Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure</title><author>Sargento, L ; Vicente Simões, A ; Rodrigues, J ; Longo, S ; Lousada, N ; Palma dos Reis, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-a227dbb4d2a6d9f575d54147deb703334384b2ba7f9918f02258b5f9f622e1a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Biomarkers - blood</topic><topic>Body Weight</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Geriatric Assessment - methods</topic><topic>Geriatric nutritional risk index</topic><topic>Heart Failure, Systolic - diagnosis</topic><topic>Heart Failure, Systolic - mortality</topic><topic>Heart Failure, Systolic - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Malnutrition - diagnosis</topic><topic>Malnutrition - mortality</topic><topic>Malnutrition - physiopathology</topic><topic>Models, Biological</topic><topic>Multivariate Analysis</topic><topic>Nutrition Assessment</topic><topic>Nutritional assessment</topic><topic>Nutritional Status</topic><topic>Outpatients</topic><topic>Portugal</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Serum Albumin - analysis</topic><topic>Serum Albumin, Human</topic><topic>Stroke Volume</topic><topic>Systolic heart failure</topic><topic>Time Factors</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sargento, L</creatorcontrib><creatorcontrib>Vicente Simões, A</creatorcontrib><creatorcontrib>Rodrigues, J</creatorcontrib><creatorcontrib>Longo, S</creatorcontrib><creatorcontrib>Lousada, N</creatorcontrib><creatorcontrib>Palma dos Reis, R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nutrition, metabolism, and cardiovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sargento, L</au><au>Vicente Simões, A</au><au>Rodrigues, J</au><au>Longo, S</au><au>Lousada, N</au><au>Palma dos Reis, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure</atitle><jtitle>Nutrition, metabolism, and cardiovascular diseases</jtitle><addtitle>Nutr Metab Cardiovasc Dis</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>27</volume><issue>5</issue><spage>430</spage><epage>437</epage><pages>430-437</pages><issn>0939-4753</issn><eissn>1590-3729</eissn><abstract>Abstract Background and aims Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model. Methods and results A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90–0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15–0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9. Conclusion The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>28438373</pmid><doi>10.1016/j.numecd.2017.02.003</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5792-6723</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Area Under Curve Biomarkers - blood Body Weight Cardiovascular Chi-Square Distribution Decision Support Techniques Female Geriatric Assessment - methods Geriatric nutritional risk index Heart Failure, Systolic - diagnosis Heart Failure, Systolic - mortality Heart Failure, Systolic - physiopathology Humans Male Malnutrition - diagnosis Malnutrition - mortality Malnutrition - physiopathology Models, Biological Multivariate Analysis Nutrition Assessment Nutritional assessment Nutritional Status Outpatients Portugal Predictive Value of Tests Prognosis Proportional Hazards Models Risk Assessment Risk Factors ROC Curve Serum Albumin - analysis Serum Albumin, Human Stroke Volume Systolic heart failure Time Factors Ventricular Function, Left |
| title | Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure |
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