Prognostic impact of nutritional indices in candidates for heart transplantation

OBJECTIVE
No study has thus far evaluated the association of controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) with prognosis in candidates listed for heart transplantation (HT). Therefore, in this study, we aimed to investigate the impact of these
nutritional indices on prognosis in these candidates.

METHODS
In this retrospective study, a total of 195 candidates for HT were included. Over a median follow-up period of 503.5 days, the patients were grouped as survivors (n=121) and non-survivors (n = 74). Malnutrition was defined as CONUT score ≥2 (CONUT-defined malnutrition) and PNI ≤38 (PNI-defined malnutrition).

RESULTS
The CONUT-defined malnutrition was observed in 19.8% and 39.2% of the survivors and non-survivors (P =.003), and the PNI-defined malnutrition was observed in 7.4% and 16.2% of the survivors and non-survivors (P =.032). The univariate analysis revealed that the CONUT score from 0 to 2 (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.11–1.79, P =.004) and PNI from 45.5 to 54.5 (HR: 0.78, 95% CI: 0.64–0.95, P =.001), the CONUT-defined malnutrition (HR: 2.48, 95% CI: 1.55–3.97, P <.001) and the PNI-defined malnutrition (HR: 1.97, 95% CI: 1.01–3.86, P =.04) were associated with mortality. In the multivariate adjusted models, the CONUT-defined malnutrition was an independent predictor of mortality, whereas the PNI-defined malnutrition was not a predictor of mortality (HR: 1.92, 95% CI: 1.12–3.27, P =.001 and HR: 1.64, 95% CI: 0.80–3.40, P =.18). The log-rank test revealed that the CONUT-defined malnutrition and the PNI-defined malnutrition were associated with decrease in survival rate.

CONCLUSION
Although both the CONUT score and the PNI score were associated with prognosis in candidates for HT, the CONUT score was superior to the PNI score in predicting mortality.