Abstract
The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Systematic review and meta-analysis. A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Ten studies involving 5196 patients with heart failure. Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.
Highlights
Inclusion and exclusion criteria Inclusion criteria were as follows: [1] population: patients with heart failure; [2] exposure: baseline controlling nutritional status (CONUT) score; [3] comparison: patients with malnutrition defined by the CONUT score ≥2 v. those with normal nutritional status; [4] outcome measures: all-cause mortality; [5] study design: prospective or retrospective observational studies and [6] reported multivariable-adjusted risk estimate of survival outcome for the malnourished v. normal nutritional status or per point CONUT score increase
A fixed-effect model meta-analysis indicated that the pooled risk ratios (RR) of all-cause mortality was 1·92 for the CONUT score ≥2 v
According to the results of subgroup analysis, malnutrition assessed by the CONUT score was associated with 1·76-fold and 2·63-fold higher risk of allcause mortality in acute heart failure and total heart failure
Summary
Literature search The current meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines[16]. Those with normal nutritional status; [4] outcome measures: all-cause mortality; [5] study design: prospective or retrospective observational studies and [6] reported multivariable-adjusted risk estimate of survival outcome for the malnourished v. The exclusion criteria included [1] studies did not select the normal nutrition (CONUT score 0–1) as reference; [2] outcome measures were not of interest and [3] lack of detailed risk summary for the outcome or reported unadjusted risk estimate. Data extraction and quality assessment The following data of each study were abstracted surname of the first author, publication year, study design (retrospective or prospective), country, type of patients, sample size, percentage of men, mean/median age or age range, left ventricular ejection fraction (LVEF) at baseline, categorical or continuous analysis of CONUT score, most fully adjusted risk estimate, follow-up duration and adjusted variables. Data analyses were conducted using Stata 12.0 (Stata Corp., College Station, TX)
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