J Nutr Health Aging
NUTRITIONAL STATE PREDICTS ALL-CAUSE DEATH INDEPENDENT OF COMORBIDITIES IN GERIATRIC PATIENTS WITH CORONARY ARTERY DISEASE B.-T. HUANG, Y. PENG, W. LIU, C. ZHANG, H. CHAI, F.-Y. HUANG, Z.-L. ZUO, Y.-B. LIAO, T.-L. XIA, M. CHEN Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China. Corresponding author: Mao Chen, Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China. Telephone: 86-189 8060 2046. Email: [email protected]
Abstract: Objective: To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD). Design: Cohort study. Setting: Patients referred for coronary angiography in West China Hospital, Sichuan University, China. Participants: 1772 patients with angiographic documented CAD whose age was above 65 years. Measurements: Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without. Results: During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35-2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death. Conclusion: Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation. Key words: Nutritional status, death, older people, coronary artery disease.
Introduction In the last two decades, a growing number of older patients with coronary artery disease (CAD), who were often concomitant with multiple non-cardiac comorbidities, have received percutaneous coronary intervention (PCI) treatment. Accordingly, in the contemporary practice, cardiac deaths in patients with CAD decrease, while, non-cardiac causes are mainly responsible for the long-term mortality rate (1). The changes of mortality pattern remind us to pay more attention to perform integrated care in CAD patients. Otherwise, the benefit brought by the improved drug therapy and revascularization treatment might be offset by the poor management of patients. Due to the effect concomitant disease, stress reaction, drugs usage, anxiety or depression, poor nutrition status is very common in older inpatients with CAD (2, 3). However, in a Denmark questionnaire-based investigation, only 24% of medical staffs performed nutritional risk screening for patients at admission (4). A nationwide study of nutritional risk prevalence and implementation of nutritional support in China demonstrated that 35.5% inpatients were at nutritional risk, while only one third of these patients received nutritional support, and it was more prominent in the departments related to internal medicine (5). Lack of recognition of the significance of nutritional risk assessment in older patients might account for the phenomenon. The aim of present study was to investigate the association between nutritional status and allcause death in older patients with CAD; further, we stratified patients by different characteristics, in order to explore whether Received February 5, 2015 Accepted for publication Februaty 26, 2015
1
the association varied across population with distinct severity of coronary disease, comorbidities, and medication. Method Participants The study population was originated from Coronary Heart Disease Database of West China Hospital, Sichuan University, which included all patients referred for coronary angiography with any indications since July 2008. Detailed description regarding the database has been published before (6, 7). Patients aged 65 years or older, with angiographically validated CAD were included into the present analysis; that was, all the patients had at lease one coronary artery narrowing more than 50%. Patients were excluded if anthropometric data or serum albumin data were unavailable. The study was approved by the Ethics Committee of West China Hospital, Sichuan University. All subjects gave informed consent. Baseline characteristics Height, weight, blood pressure, and heart rate were measured by experienced nurses at admission. Body mass index (BMI) was calculated as the ratio of weight (kg)/height squared (m2). Medical history, risk factors, serologic data, echocardiographic measurement, angiographic findings, and medication at discharge were accessed by screening medical chart or interview.
J Nutr Health Aging
NUTRITIONAL STATE PREDICTS ALL-CAUSE DEATH INDEPENDENT OF COMORBIDITIES IN PATIENTS WITH CAD Nutritional risk assessment Nutritional state was appraised using the geriatric nutritional risk index (GNRI). GNRI was calculated as follows (8): GNRI= 1.489 × serum albumin (g/L) + 41.7 × BMI/22. Study participants were divided into two groups according to their
GNRI: >98 and ≤98 . As previous study suggested (9), patients with GNRI > 98 were considered to be with no nutritional risk, otherwise, the opposite.
Table 1 Baseline characteristics of study participants Characteristics
Total (n=1772 )
Nutritional risk (n= 386)
No nutritional risk (n=1386)
P value
73.8±5.5
72.1±4.8
NUTRITIONAL STATE PREDICTS ALL-CAUSE DEATH INDEPENDENT OF COMORBIDITIES IN GERIATRIC PATIENTS WITH CORONARY ARTERY DISEASE B.-T. HUANG, Y. PENG, W. LIU, C. ZHANG, H. CHAI, F.-Y. HUANG, Z.-L. ZUO, Y.-B. LIAO, T.-L. XIA, M. CHEN Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China. Corresponding author: Mao Chen, Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China. Telephone: 86-189 8060 2046. Email: [email protected]
Abstract: Objective: To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD). Design: Cohort study. Setting: Patients referred for coronary angiography in West China Hospital, Sichuan University, China. Participants: 1772 patients with angiographic documented CAD whose age was above 65 years. Measurements: Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without. Results: During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35-2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death. Conclusion: Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation. Key words: Nutritional status, death, older people, coronary artery disease.
Introduction In the last two decades, a growing number of older patients with coronary artery disease (CAD), who were often concomitant with multiple non-cardiac comorbidities, have received percutaneous coronary intervention (PCI) treatment. Accordingly, in the contemporary practice, cardiac deaths in patients with CAD decrease, while, non-cardiac causes are mainly responsible for the long-term mortality rate (1). The changes of mortality pattern remind us to pay more attention to perform integrated care in CAD patients. Otherwise, the benefit brought by the improved drug therapy and revascularization treatment might be offset by the poor management of patients. Due to the effect concomitant disease, stress reaction, drugs usage, anxiety or depression, poor nutrition status is very common in older inpatients with CAD (2, 3). However, in a Denmark questionnaire-based investigation, only 24% of medical staffs performed nutritional risk screening for patients at admission (4). A nationwide study of nutritional risk prevalence and implementation of nutritional support in China demonstrated that 35.5% inpatients were at nutritional risk, while only one third of these patients received nutritional support, and it was more prominent in the departments related to internal medicine (5). Lack of recognition of the significance of nutritional risk assessment in older patients might account for the phenomenon. The aim of present study was to investigate the association between nutritional status and allcause death in older patients with CAD; further, we stratified patients by different characteristics, in order to explore whether Received February 5, 2015 Accepted for publication Februaty 26, 2015
1
the association varied across population with distinct severity of coronary disease, comorbidities, and medication. Method Participants The study population was originated from Coronary Heart Disease Database of West China Hospital, Sichuan University, which included all patients referred for coronary angiography with any indications since July 2008. Detailed description regarding the database has been published before (6, 7). Patients aged 65 years or older, with angiographically validated CAD were included into the present analysis; that was, all the patients had at lease one coronary artery narrowing more than 50%. Patients were excluded if anthropometric data or serum albumin data were unavailable. The study was approved by the Ethics Committee of West China Hospital, Sichuan University. All subjects gave informed consent. Baseline characteristics Height, weight, blood pressure, and heart rate were measured by experienced nurses at admission. Body mass index (BMI) was calculated as the ratio of weight (kg)/height squared (m2). Medical history, risk factors, serologic data, echocardiographic measurement, angiographic findings, and medication at discharge were accessed by screening medical chart or interview.
J Nutr Health Aging
NUTRITIONAL STATE PREDICTS ALL-CAUSE DEATH INDEPENDENT OF COMORBIDITIES IN PATIENTS WITH CAD Nutritional risk assessment Nutritional state was appraised using the geriatric nutritional risk index (GNRI). GNRI was calculated as follows (8): GNRI= 1.489 × serum albumin (g/L) + 41.7 × BMI/22. Study participants were divided into two groups according to their
GNRI: >98 and ≤98 . As previous study suggested (9), patients with GNRI > 98 were considered to be with no nutritional risk, otherwise, the opposite.
Table 1 Baseline characteristics of study participants Characteristics
Total (n=1772 )
Nutritional risk (n= 386)
No nutritional risk (n=1386)
P value
73.8±5.5
72.1±4.8
