The Clinical Value Of The CONUT Score For Predicting Prognosis In Systolic Heart Failure Cases In The Vulnerable Phase

Purpose: To explore the predictive value of Controlling Nutritional Status(CONUT)score for the prognosis of patients with systolic Heart failure(HF)in the vulnerable phase,and to provide additional information for the prediction of poor prognosis in patients during the vulnerable phase.Methods: Totally 187 systolic heart failure cases were retrospectively assessed at The Second Hospital of Dalian Medical University.Based on CONUT score at admission,cases were assigned to 3 groups,including the normal nutrition,and mild and moderate or severe malnutrition groups.The primary endpoint was all-cause death in the 90 days following discharge.The secondary,composite outcome encompassed all-cause death and rehospitalization due to heart failure.Kaplan-Meier method and log-rank test were performed to compare outcome event rates between groups.Independent risk factors for outcome events were obtained by multivariate COX regression analysis for variables with p < 0.05 in univariate regression analysis and for variables considered to be clinically significant for survival outcome in HF.The receiver operating characteristic(ROC)curve analysis and the De Long test were used to compare the prediction performance of the CONUT score and other independent risk factors for all-cause death.Results:1.Among the 187 cases,77.5% had varying degrees of malnutrition.In the baseline information,compared to the normal nutrition group,the moderate or severe malnutrition group showed reduced hemoglobin,triglyceride and low density lipoprotein(LDL)cholesterol(P <0.05),as well as decreased CONUT score indexes(albumin,total cholesterol and lymphocyte count),and elevated BNP and NT-pro BNP amounts(P <0.05).2.During the 90 days of follow-up,8.6% of HF patients had the primary endpoint and23.5% had the secondary outcome.3.All-cause mortality was markedly elevated in the moderate or severe malnutrition group(Logrank: P <0.001).Compared with normal nutrition group,composite endpoint events had starkly increased incidence rates in both malnutrition groups,and the incidence increased with the severity of malnutrition(Logrank: P <0.05).4.Univariate regression analysis showed that age,hemoglobin,glomerular filtration rate(e GFR),glutamate transaminase(AST),BNP,and CONUT score were risk factors for all-cause mortality events.Multivariate COX risk analysis revealed higher CONUT score(hazard ratio [HR]=1.791,95% confidence interval [CI] 1.379-2.327),age(HR=1.08,95%CI 1.028-1.134),B-type natriuretic peptide(BNP)(HR=1.001,95%CI1.000-1.001)and aspartate aminotransferase(AST)(HR=1.008,95%CI 1.001-1.015)at admission as independent predictive factors of all-cause mortality.Among the secondary outcome events,the following were their risk factors: age,heart rate,hemoglobin,e GFR,and CONUT score.And higher CONUT score(HR =1.162,95%CI1.024-1.318)and lower estimated glomerular filtration rate(e GFR)(HR=0.98,95%CI0.966-0.993)were independent predictive factors for the secondary endpoint.5.In the ROC curve for predicting all-cause mortality in the vulnerable period,the AUC of CONUT score was the largest,and there was no significant difference compared with age and BNP(De Long test: P > 0.05).In addition,the addition of the CONUT score significantly increased the predictive performance of age,BNP and AST,as well as their combination for all-cause death respectively(De Long test: all P <0.05).Conclusion:1.Malnutrition is not uncommon in systolic HF cases.2.Patients with systolic heart failure have a higher incidence of adverse events during the vulnerable phase.3.Systolic HF cases with malnutrition were more likely to have adverse outcome events.4.Higher CONUT score,age,BNP and AST at admission were independent risk factors for all-cause mortality during the vulnerable period.Higher CONUT score and lower e GFR were independent risk factors for secondary outcomes.5.The predictive value of CONUT score for the prognosis of patients with systolic heart failure in vulnerable period was not inferior to the traditional risk factors,and combined with it can further improve the predictive efficiency.