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A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support

Background: A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have...

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Autores principales: Minami-Takano, Asuka, Iwata, Hiroshi, Miyosawa, Katsutoshi, Kubota, Kyoko, Kimura, Atsushi, Osawa, Shota, Shitara, Minako, Okazaki, Shinya, Suwa, Satoru, Miyauchi, Katsumi, Sumiyoshi, Masataka, Amano, Atsushi, Daida, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627834/
https://www.ncbi.nlm.nih.gov/pubmed/31238536
http://dx.doi.org/10.3390/nu11061420
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author Minami-Takano, Asuka
Iwata, Hiroshi
Miyosawa, Katsutoshi
Kubota, Kyoko
Kimura, Atsushi
Osawa, Shota
Shitara, Minako
Okazaki, Shinya
Suwa, Satoru
Miyauchi, Katsumi
Sumiyoshi, Masataka
Amano, Atsushi
Daida, Hiroyuki
author_facet Minami-Takano, Asuka
Iwata, Hiroshi
Miyosawa, Katsutoshi
Kubota, Kyoko
Kimura, Atsushi
Osawa, Shota
Shitara, Minako
Okazaki, Shinya
Suwa, Satoru
Miyauchi, Katsumi
Sumiyoshi, Masataka
Amano, Atsushi
Daida, Hiroyuki
author_sort Minami-Takano, Asuka
collection PubMed
description Background: A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have previously proposed a novel nutritional index, which can be calculated using serum levels of triglycerides, total cholesterol, and body weight (TCBI). In this study, to expand the application of TCBI for critical patients, we investigated the usefulness of TCBI to predict prognosis in hemodynamically unstable patients with percutaneously implantable mechanical circulatory support (MCS) devices in the ICU. Patients and Methods: This is a retrospective analysis of a multicenter registry consisting of three Juntendo University hospitals in Japan involving patients who received MCS devices, including intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (VA-ECMO), between 2012 and 2016 (n = 439). The median follow-up period was 298 days. Results: Spearman’s correlation coefficient between TCBI and the geriatric nutritional risk index (GNRI) was 0.44 (p < 0.0001), indicating a moderate positive correlation for these two variables. Unadjusted Kaplan–Meier analysis demonstrated reduced risks of all-cause and cardiovascular mortalities in patients with higher tertiles of TCBI. Furthermore, adjusted multivariate Cox proportional hazard analyses revealed that the highest tertile TCBI was an independent predictor for the reduced risk of all-cause mortality (hazard ratio (HR): 0.22, 95% confidence interval: 0.10–0.48, p < 0.0001) and cardiovascular mortality (0.20, 0.09–0.45, p < 0.0001). Conclusion: A novel and simple to calculate nutritional index, TCBI, can be applicable as a prognostic indicator in hemodynamically unstable patients requiring MCS devices.
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spelling pubmed-66278342019-07-23 A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support Minami-Takano, Asuka Iwata, Hiroshi Miyosawa, Katsutoshi Kubota, Kyoko Kimura, Atsushi Osawa, Shota Shitara, Minako Okazaki, Shinya Suwa, Satoru Miyauchi, Katsumi Sumiyoshi, Masataka Amano, Atsushi Daida, Hiroyuki Nutrients Article Background: A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have previously proposed a novel nutritional index, which can be calculated using serum levels of triglycerides, total cholesterol, and body weight (TCBI). In this study, to expand the application of TCBI for critical patients, we investigated the usefulness of TCBI to predict prognosis in hemodynamically unstable patients with percutaneously implantable mechanical circulatory support (MCS) devices in the ICU. Patients and Methods: This is a retrospective analysis of a multicenter registry consisting of three Juntendo University hospitals in Japan involving patients who received MCS devices, including intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (VA-ECMO), between 2012 and 2016 (n = 439). The median follow-up period was 298 days. Results: Spearman’s correlation coefficient between TCBI and the geriatric nutritional risk index (GNRI) was 0.44 (p < 0.0001), indicating a moderate positive correlation for these two variables. Unadjusted Kaplan–Meier analysis demonstrated reduced risks of all-cause and cardiovascular mortalities in patients with higher tertiles of TCBI. Furthermore, adjusted multivariate Cox proportional hazard analyses revealed that the highest tertile TCBI was an independent predictor for the reduced risk of all-cause mortality (hazard ratio (HR): 0.22, 95% confidence interval: 0.10–0.48, p < 0.0001) and cardiovascular mortality (0.20, 0.09–0.45, p < 0.0001). Conclusion: A novel and simple to calculate nutritional index, TCBI, can be applicable as a prognostic indicator in hemodynamically unstable patients requiring MCS devices. MDPI 2019-06-24 /pmc/articles/PMC6627834/ /pubmed/31238536 http://dx.doi.org/10.3390/nu11061420 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Minami-Takano, Asuka
Iwata, Hiroshi
Miyosawa, Katsutoshi
Kubota, Kyoko
Kimura, Atsushi
Osawa, Shota
Shitara, Minako
Okazaki, Shinya
Suwa, Satoru
Miyauchi, Katsumi
Sumiyoshi, Masataka
Amano, Atsushi
Daida, Hiroyuki
A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title_full A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title_fullStr A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title_full_unstemmed A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title_short A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support
title_sort novel nutritional index serves as a useful prognostic indicator in cardiac critical patients requiring mechanical circulatory support
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627834/
https://www.ncbi.nlm.nih.gov/pubmed/31238536
http://dx.doi.org/10.3390/nu11061420
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