Study On The Prognostic Value Of Nutritional Indicators In Elderly Patients With Heart Failure And The Cardiotoxicity Associated With Immune Checkpoint Inhibitor

Background:Lymphocyte count(LYM),serum albumin(ALB),and total cholesterol(CHOL)are simple and easy to obtain,and have been proven to be prognostic indicators related to malnutrition in patients with heart failure.However,there are few studies on them in elderly patients with heart failure,and currently there is a lack of large sample size,long-term follow-up clinical studies on the correlation between LYM,ALB,and CHOL and the prognosis of hospitalized elderly patients with heart failure in China.Objective:We aimed to explore the prevalence of malnutrition,its associations and prognostic significance among elder patients with HF using LYM,ALB,and CHOL.Methods:Consecutively presenting patients aged>65 years,diagnosed with HF,and admitted to HF care unit were assessed for nutritional indices.Results:A total of 1371 patients were enrolled,with a median age of 72 years(interquartile range:68-77 years),of whom 59.4%were male.Using the evaluation criteria of LYM<1.6*109,ALB<35g/L and CHOL≤4.65mmol/L,56.7%,21.9%,and 72.1%of patients suffered from malnutrition,respectively.The median follow-up time was 962 days(interquartile interval:903-1029 days),and 388 patients(28.3%)experienced all-cause death.After adjusting for clinical characteristics,causes and complications of heart failure,laboratory tests,and medication,patients with moderate or severe malnutrition evaluated using LYM or ALB had a significantly increased risk of all cause death compared to patients with normal nutritional status,while the risk of all cause death in patients with malnutrition evaluated using CHOL was not statistically significant compared to those with normal nutritional status.Conclusion:A decrease in baseline serum albumin or lymphocyte count is associated with an increased risk of all-cause death in elderly patients with heart failure.Background:Lack of standard diagnostic criteria in elder patients with heart failure(HF)makes it challenging to diagnose and manage malnutrition.Objective:We aimed to explore the prevalence of malnutrition,its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems.Methods:Consecutively presenting patients aged>65 years,diagnosed with HF,and admitted to HF care unit were assessed for nutritional indices.Results:In total,1371 patients were enrolled(59.4%men;mean age 72 years;median NT-proBNP 2343 ng/l).Using scores for PNI≤38,CONUT score>4,GNRI≤91,and TCBI≤1109,10.4%,18.3%,9.2%and 50.0%of patients had moderate or severe malnutrition,respectively.There was a strong association between worse scores and lower body mass index,more severe symptoms,atrial fibrillation,and anemia.The mortality over a median follow-up of 962 days(IQR:903 to 1029 days)was 28.3%(n=388).For those with moderate or severe,1-year mortality was 35.2%for PNI,28.3%for CONUT,28.0%for GNRI and 19.1%for TCBI.Malnutrition defined by any of the included indices showed added prognostic value when incorporated into a model included preexisting prognostic factors(C-statistic:0.711).However,defining malnutrition by CONUT score yielded the most significant improvement in prognostic predictive value(C-statistic:0.721;p<0.001).Conclusion:Malnutrition is prevalent among elder patients with HF and confers increased mortality risk.Among the nutritional scores studied,the CONUT score was most effective in predicting mortality risk.Background:Although malnutrition predict prognosis for heart failure(HF),it is unclear which patients might benefit maximally from nutritional strategies.Objective:We hypothesize that inflammation may identify elderly HF patients at high risk of malnutrition-associated mortality,and thereby identify those most likely to benefit from anti-inflammatory interventions.Methods:Consecutively presenting patients aged≥65 years,diagnosed with HF,and admitted to HF care unit were assessed for nutritional and inflammation indices.Results:In total,1358 patients with HF aged≥ 65 years were enrolled(60.1%men;mean age 72 years;median NT-proBNP 2291 ng/l).Nutritional status was evaluated by PNI,CONUT,GNRI and TCBI,and inflammation were measured on admission.The sample was stratified based on high-sensitivity C-reactive protein(hsCRP)levels(≥2 vs.<2 mg/L).In patients with hsCRP level<2mg/L,malnutrition patients evaluated by other indicators except PNI were not related to the increase of cumulative incidence rate of allcause mortality;However,in patients with hsCRP≥2mg/L,the aggravation of malnutrition assessed by any index was associated with the increase of cumulative incidence rate of allcause mortality,and showed an increasing trend over time(p<0.05).Conclusion:Malnutrition is related to all-cause mortality among those with hsCRP levels above 2mg/L,but not when hsCRP levels are below 2mg/L.Background:Inflammatory biomarkers,including CRP,the neutrophil-to-lymphocyte ratio(NLR)and the neutrophil-to-eosinophil ratio(NER),may predict outcomes in cancer.However,their value in immune checkpoint inhibitor(ICI)therapy associated cardiotoxicity remains elusive.Objective:We aimed to characterize the relationship of inflammatory markers with severity of iRCs and prognosis among patients with ICI-related cardiotoxicities(iRCs).Methods:Patients who diagnosed with iRCs between January 2019 and December 2021 were retrospectively enrolled and were dichotomized based on iRC severity into low-grade(grade 1-2)vs high-grade(grade 3-4)groups.Results:Forty-seven patients were included.The median time-to-event from first ICI infusion to onset of iRCs was 35 days(IQR:19.0 to 65.5 days).When compared with respective baseline values,cardiac biomarkers and inflammatory markers were significantly elevated at onset of iRCs.Compared to low-grade iRCs,NER at iRCs onset was significantly increased among patients with high-grade iRCs(Group×Time,p<0.01).When grouped by the median NER(184.33)at iRCs onset,NER≥184.33 was associated with high-grade iRCs(OR:10.77,p<0.05)and had a 36.3%increased mortality compared to the lower NER group(HR:2.67,p<0.05).Conclusion:In patients who develop iRCs,NER is significantly elevated at iRCs onset,and higher NER correlates with greater iRC severity and higher mortality.Larger datasets are needed to validate these findings.