Indice de masse corporelle et albuminémie péri-implantatoires de patients sous assistance circulatoire mécanique (ACM) en attente d'une transplantation cardiaque

Abstract

Objective. – To evaluate the prognostic influence of peri-implantation nutritional status of patients under mechanical circulatory assist (MCA) prior to cardiac transplantation (CT). Study design. – Retrospective analysis of patients with cardiogenic shock included from June 1997 to December 2002. Patients and methods. – Evaluation at MCA's implantation, at day (D) 30 and at CT or patient's death (D) of body mass index (BMI = body weight (kg)/size (m 2), albuminemia (Alb g/l), expressed as median values (med) and range (min-max). Odds ratio (OR) and CI 95%) were calculated. A multivariate analysis was performed to determine variables related to D or CT success. Results. – Thirty-four patients (30 men), median age 40.5 years (10–63), were included. MCA types were cardiac pumps ( N = 3); pneumatic ( N = 18) or electric ( N = 5) ventricular assist devices and artificial heart ( N = 8). Global mortality was 56% (19 over 34 patients) and at implantattion in the global population ( N = 34) BMI was19.4 (9.3-28.1) and Alb 24.6 g/l (15–37.5). At MCA's implantation and D30 respectively, 38 and 42% of the patients had a severe hypoAlb (Alb < 30 g/l) and a BMI < 19 attesting of a seriously deteriorated nutritional status. No significant statistical difference was observed on median BMI of transplanted patients T ( N = 15) and expired patients D ( N = 19). Alb was significantly different ( p < 10 −4) between T and D patients: median Alb: 30 g/l (20–37.5) in T patients, 20 g/l (15–31) in D patients. HypoAlb < 21 g/l was an independent prognostic factor of death ( p = 0.004; OR: 0.541; IC95% : 0.36–0.82) and Alb > 33 g/l an independent prognostic factor of CT success ( p = 0.003; OR:1.38; IC95% : 1.12–1.71). Conclusion. – These results seem to demonstrate that at MCA implantation, a seriously deteriorated albuminemia level (< 30 g/l) negatively impacts patients overall survival after CT.