Prognostic Value Of Nutritional State Based On The Controlling Nutritional Status Score For Mortality In Patients With Dilated Cardiomyopathy

BackgroundDilated cardiomyopathy(DCM)is one of the common causes resulting in chronic heart failure(HF)and heart transplant.Although the treatment strategies and comprehensive management are constantly being optimized,most patients with DCM still have to face poor prognosis.Previous studies have found that malnutrition is widespread in patients with cardiovascular disease and closely related to the prognosis of these patients.The controlling nutritional status(CONUT)score can be used for early screening and continuous monitoring of inpatients’ nutritional status due to its advantages of simplicity,convenience and objectivity.However,the relation between nutritional status based on CONUT score and prognosis of DCM patients remains unclear.ObjectiveThe aim of this study was to investigate the relationship between the nutritional status based on the CONUT score and the mortality in patients with DCM.MethodsWe retrospectively analyzed clinical data of 235 DCM patients hospitalized in the cardiovascular department of Zhongda hospital from January 2014 to October 2018 in thorough.All clinical baseline data of patients was gathered including general situation,the results of blood test and echocardiography.According to the CONUT score,patients were classified into two groups:normal-nutrition and malnutrition.The following information of all patients was obtained from telephone follow-up.The end point of this study was defined as all-cause death within one year after discharge.Comparisons of clinical data between two groups were fulfilled.Spearman’s correlation was performed to examine the relationship between CONUT score and other variables.The survival time of the patients was calculated by Kaplan-Meier method,and Log-rank test was used to evaluate the survival difference between the two groups.Cox proportional hazard regression model was used for multivariate analysis to assess the correlation between nutritional status and allcause mortality of patients with DCM.The predictive value of CONUT score for mortality in DCM patients was evaluated by receiver operating characteristic curves(ROC).Results(1)According to the CONUT score,patients with malnutrition accounted for 61.7%(n = 145)of all study population.Compared with patients in the normal-nutrition group,those with malnutrition were older(P < 0.05),and the use of β-blocker,red blood cell count,hemoglobin,platelet count,lymphocyte count,triglyceride,total protein,albumin,total cholesterol,low-density lipoprotein cholesterol and fibrinogen levels were significantly lower(P < 0.05),but the prevalence of atrial fibrillation and D-dimer levels were significantly higher(P < 0.05).(2)Spearman correlation analysis showed that age,aspartate aminotransferase(AST),urea nitrogen and D-dimer levels were positively correlated with CONUT score(P < 0.05).However,body mass index,systolic blood pressure,red blood cell count,hemoglobin,platelets,triglycerides,low-density lipoprotein cholesterol and fibrinogen levels were negatively correlated with CONUT score(P < 0.05).(3)There were 26(11.1%)patients died within 1 year after discharge,3(3.3%)of which were in the normal-nutrition group and 23(15.8%)were in the malnutrition group.Kaplan-Meier survival analysis indicated that the risk of all-cause death in patients with malnutrition is significantly higher than those with normal-nutrition(Log-rank P = 0.003).(4)The univariate analysis results showed that nutritional status based on CONUT score,systolic blood pressure at admission,New York heart association class,the use of angiotensinconverting enzyme inhibitor or angiotensin receptor blockade or statins,red blood cell count,alanine aminotransferase,AST,urea nitrogen,creatinine,uric acid,D-dimer,left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter can significantly influence the mortality of patients with DCM(P < 0.05).(5)The multifactor Cox regression model showed that malnutrition based on the CONUT score,urea nitrogen levels and LVEF remain independent predictors for all-cause death in DCM patients after adjusting for other potential confounders.(6)The ROC curve showed that the area under curve was 0.680(95% CI: 0.585-0.775,P =0.003),and the CONUT score cutoff value at 1.5(with the actual record ≥ 2)exhibited a 88.5%sensitivity and 41.6% specificity.ConclusionMalnutrition based on the CONUT score is common among patients with DCM and significantly associated with increased mortality.Nutritional assessment based on CONUT score may provide additional prognostic information for these people.