Abstract 12877: Malnutrition Assessed by Geriatric Nutritional Index Provides the Additional Long-Term Prognostic Information to Renal Dysfunction in Patients Admitted for Acute Decompensated Heart Failure

Abstract

Backgrounds: Renal dysfunction has emerged as one of the most potent prognostic indicators in patients with heart failure. Hospitalization for acute decompensated heart failure (ADHF) isassociated with a high mortality after discharge. Malnutrition is also associated with poor outcome in ADHF pts. However, there is no information available on the long-term prognostic significance of malnutrition, relating to renal dysfunction in ADHF patients. Methods and Results: We studied 305 consecutive ADHF patients discharged with survival. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 x serum albumin (g/dl) + 41.7 x body mass index/22. During a follow-up period of 4.2±3.2 yrs, 69 patients had cardiovascular death (CVD). At multivariate Cox analysis, GNRI at discharge (p=0.003) and estimated glomerular filtration rate (GFR) (p=0.03) were significantlyassociated with CVD, independently of systolic blood pressure, serum sodium level and prior heart failure hospitalization. Receiver-operator curve analysis revealed that GNRI of 88 was a fair discriminator for CVD (AUC 0.698 (95%CI 0.628-0.768), p<0.0001). In patients with renal dysfunction defined as low GFR (<the median value:54.5ml/min/1.73m 2 ), CVD was significantly more frequently observed in pts with than without low GNRI <88 (52% vs 26%, p<0.0001, the adjusted hazard ratio (HR):2.7 (95%CI 1.5-4.8)). Furthermore, in group without renal dysfunction, pts with low GNRI had the significantlyincreased risk, compared to those with high GNRI>88 (28% vs 6%, p<0.0001, the adjusted HR:4.7 (95%CI 1.6-13.4)). Conclusion: Malnutrition Assessed by Geriatric Nutritional Index provides the long-term prognostic information in patients admitted for acute decompensated heart failure, irrespective of renal dysfunction.