| Institution: | 1. Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University, Wuxi, Jiangsu, 214122, China;2. Wuxi Municipal Center for Disease Control and Prevention, Wuxi, Jiangsu, 214023, China;3. Institutes of Biology and Medical Sciences, Soochow University, Suzhou, Jiangsu, 215000, China;1. Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C.Heymanslaan 10 - 4K3, 9000 Ghent, Belgium;2. Departments of Public Health Nutrition, Faculty of Public Health, Mulawarman University, Samarinda, East Kalimantan, Indonesia;3. Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre D''investigation Clinique, F-59000 Lille, France;4. Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE – Institute for Translational Research in Inflammation, F-59000 Lille, France;5. GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Science, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain;6. Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain;7. Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Spain;8. Instituto de Salud Carlos III, Madrid, Spain;1. Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy;2. Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy;3. Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin - Corso Svizzera, 164-10149, Turin, Italy;1. Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea;2. Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea |
| Abstract: | Background and aimsBoth malnutrition and hyponatremia (serum sodium <135 mmol/L) can be induced by the impaired absorption function of the edematous intestinal wall caused by heart failure (HF) and are prognostic factors of mortality in HF. However, little is known about the interrelationship of nutritional status and hyponatremia in mortality risk prediction in HF.Methods and resultsThis study enrolled 2882 HF patients admitted to the HF care unit of Fuwai Hospital, Beijing, China from 2008 to 2018; 71.3% were male and the mean age was 56.64 ± 15.96 years. Nutritional status was assessed by prognostic nutritional index (PNI), calculated as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Lower PNI indicates worse nutritional status. Patients were divided into 8 groups based on baseline PNI quartiles (Q1: <43.6, Q2: 43.6–48.55, Q3: 48.55–63.25, Q4: >63.25) and sodium level (normal sodium and hyponatremia). After adjustment, patients in the PNI Q1 associated with hyponatremia had a 2.12-fold higher risk of all-cause death (95% confidence interval CI]: 1.67–2.70) compared with those in the PNI Q4 with normal sodium. A refinement in risk prediction was observed after adding PNI quartile and serum sodium category to the original model (ΔC-statistic = 0.018, 95% CI: 0.007–0.025; net re-classification index = 0.459, 95% CI: 0.371–0.548; integrated discrimination improvement = 0.025, 95% CI: 0.018–0.032).ConclusionHF patients with both the lowest PNI quartile and hyponatremia are at higher risk of all-cause mortality. The combination of PNI and serum sodium level enhanced the predictive value for all-cause mortality in hospitalized HF patients.Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818. |
