The change in nutritional status is related to cardiovascular events in patients with pacemaker implantation: A 4-year follow-up study

Kaijing Wang; Liyou Lian; Chengpu Chen; Meiling Wang; Chen Chen; Xiang Hu

doi:10.3389/fnut.2022.986731

The change in nutritional status is related to cardiovascular events in patients with pacemaker implantation: A 4-year follow-up study

Front Nutr. 2022 Sep 2:9:986731. doi: 10.3389/fnut.2022.986731. eCollection 2022.

Authors

Kaijing Wang¹, Liyou Lian^{2

3}, Chengpu Chen^{2

3}, Meiling Wang^{2

3}, Chen Chen^{2

3}, Xiang Hu⁴

Affiliations

¹ Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
³ The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China.
⁴ Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Abstract

Background: The aim of our study was to evaluate changes in nutritional status as measured by the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) scores, and their abilities to predict clinical prognosis in patients with pacemaker implantation (PMI).

Methods: A total of 595 patients who underwent permanent PMI from January 2011 to December 2020 were included. PNI and GNRI scores were separately calculated at the beginning day of PMI operation and at the end of 12-month follow-up, and their net changes (Δ) were calculated by PNI or GNRI scores at follow-up minus the corresponding scores on admission. The cohort patients were divided into low risk of malnutritional status (ΔPNI or ΔGNRI scores ≥ 0) and high risk of malnutritional status (ΔPNI or ΔGNRI scores < 0) groups. Primary outcome measure was a composite major adverse cardiovascular event (MCE), defined as heart failure hospitalization (HFH), myocardial infarction (MI), stroke, or death from any cause, presented as hazard ratios (HR) with 95% confidence intervals (CI) calculated by MCE in the crude or multivariate-adjusted Cox Proportional Hazards models. Receiver operating characteristic (ROC) curve analysis was used to compare the differential ability to predict incident MCEs betweenΔPNI andΔGNRI scores.

Results: In total, 16% of patients developed the MCE during the follow-up. The cumulative event rates determined by Kaplan-Meier analysis were significantly higher in the high risk of malnutritional patients compared to the low risk of malnutritional patients (P < 0.05). Adjusted multivariate analysis showed that decreased PNI scores (HR: 2.228, 95% CI: 1.482-3.350) and decreased GNRI scores (HR: 2.178, 95% CI: 1.439-3.295) were independently associated with favorable outcomes. ROC curve analysis revealed an area under curve (AUC) of 0.586 forΔPNI scores and AUC of 0.592 for ΔGNRI scores, but their predictive abilities were not statistically different.

Conclusion: Either positive change of PNI or GNRI scores were associated with reduced risk of MCEs in patients with PMI, and they have similar ability to predict clinical cardiometabolic risk. Additional enhancing nutritional status during follow-up may help to prevent unfavorable prognosis in clinical practices.

Keywords: geriatric nutritional risk index; nutritional status; pacemaker implantation; prognosis; prognostic nutritional index.