TY - JOUR
T1 - Decreased Nutritional Risk Index is associated with mortality after heart transplantation
AU - Krishnan, Aravind
AU - Bigelow, Benjamin
AU - Hsu, Steven
AU - Gilotra, Nisha A.
AU - Sharma, Kavita
AU - Choi, Chun Woo
AU - Kilic, Ahmet
N1 - Funding Information:
The authors have nothing to disclose. The authors would like to acknowledge the Society of Thoracic Surgeons for the opportunity to share our scientific work with our colleagues
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/5
Y1 - 2021/5
N2 - Introduction: Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation. Methods: The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all-cause mortality. Results: A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate-to-severe malnutrition was associated with increased mortality (HR = 1.18, p <.001, 95%CI: 1.13-1.24), and post-transplant renal failure requiring dialysis (OR: 1.13, p <.001, 95%CI: 1.03-1.23). Conclusion: Malnourishment determined by NRI is independently associated with mortality and post-transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.
AB - Introduction: Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation. Methods: The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all-cause mortality. Results: A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate-to-severe malnutrition was associated with increased mortality (HR = 1.18, p <.001, 95%CI: 1.13-1.24), and post-transplant renal failure requiring dialysis (OR: 1.13, p <.001, 95%CI: 1.03-1.23). Conclusion: Malnourishment determined by NRI is independently associated with mortality and post-transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.
KW - United Network for Organ Sharing
KW - biomarker
KW - nutrition
KW - registry / registry analysis
KW - rehabilitation
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U2 - 10.1111/ctr.14253
DO - 10.1111/ctr.14253
M3 - Article
C2 - 33576056
AN - SCOPUS:85101630611
SN - 0902-0063
VL - 35
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 5
M1 - e14253
ER -