Mustafa Azmi SUNGUR, Aylin SUNGUR, Fatma CAN, Aycan ESEN, Barış GÜNGÖR, Özlem YILDIRIMTÜRK

Pulmoner arteriyel hipertansiyonlu hastalarda nütrisyonel durum kontrolü (CONUT) skorunun mortalite ile ilişkisi

Amaç: Birçok kronik hastalıkta olumsuz sonuçlarla ilişkili olduğu gösterilen malnütrisyonun, pulmoner arteriyel hipertansiyonda (PAH) prognoz ile ilişkisi net değildir. Bu çalışmada, PAH hastalığında Nütrisyonel Durum Kontrolü (CONUT) skoru ile uzun dönem mortalite arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve yöntem: 2013 ve 2020 tarihleri arasında PAH tanısı alan tüm ardışık hastalar retrospektif olarak incelendi. Tanı anındaki CONUT skoru; toplam lenfosit sayısı, albümin ve total kolesterol düzeyleri ile hesaplandı. Birincil sonlanım uzun dönem tüm nedenlere bağlı mortalite olarak belirlendi. Hastalar 62 (31,3-91,5) ay takip edildi. Bulgular: Çalışmaya 92 hasta dahil edildi. Ortalama yaşı 43,9±15,7 olan hasta grubunun %65,2’si kadındı. Hastaların %37’sinde CONUT skoruna göre herhangi bir derecede malnütrisyon mevcuttu (CONUT skoru ≥2). Malnütrisyon tespit edilmeyen hastalar, risk değerlendirme skorlarına göre düşük risk kategorisinde anlamlı olarak daha fazla yer almaktaydı (ESC/ERS kılavuzu risk skorlama sistemine göre %44,8’e karşı %17,6, p=0,03; REVEAL 2.0 risk sınıflamasına göre %70,7’ye karşı %35,3, p<0,01; REVEAL Lite 2 risk sınıflamasına göre %70,7’ye karşı %32,4, p<0,01). Çok değişkenli analizde, ESC/ERS kılavuzu risk skoru ile düzeltme yapıldıktan sonra, CONUT skoru (HR:1,51, 95% CI:1,01-1,52, p=0,03) uzun dönem tüm nedenlere bağlı mortaliteyi bağımsız olarak öngördürmekteydi. Sonuç: CONUT skoru, PAH'lı hastalarda kötü prognoz ile ilişkilidir ve bu hasta grubunda hastalığın şiddetini gösterebilir.

Anahtar Kelimeler:

Pulmoner arteriyel hipertansiyon, malnütrisyon, nütrisyonel durum kontrolü skoru, mortalite

Relationship between CONUT score and mortality in patients with pulmonary arterial hypertension

Purpose: Data about the association of malnutrition with prognosis in pulmonary arterial hypertension (PAH) is limited. This study aims to evaluate the relationship of Controlling Nutritional Status (CONUT) score with long-term mortality in PAH. Materials and methods: All consecutive patients newly diagnosed with PAH between 2013 and 2020 were evaluated. CONUT score at diagnosis was calculated through total lymphocyte, albumin and total cholesterol levels. Primary outcome was long-term all-cause mortality. Patients were followed up for 62 (31.3-91.5) months. Results: 92 patients (mean age=43.9±15.7 years, 65.2% women) were included. 37% of the patients had any degree of malnutrition according to CONUT score (≥2). Patients without malnutrition were significantly more in the low-risk categories of risk stratification tools (44.8% vs 17.6% according to ESC/ERS guideline, p=0.03; 70.7% vs 35.3% and 70.7% vs 32.4% according to REVEAL 2.0 and REVEAL Lite 2, p<0.01 for both). In multivariate analysis, CONUT score predicted all-cause mortality (HR:1.51, 95% CI:1.01-1.52, p=0.03) independently after adjustment with ESC/ERS guideline risk score. Conclusion: CONUT score is independently associated with worse outcome in PAH patients and may indicate severe disease in this patient group.

Keywords:

Pulmonary arterial hypertension, malnutrition, controlling nutritional status score, mortality,

PDF

___

1. Galiè N, Humbert M, Vachiery JL, et al. ESC scientific document group. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016;37:67-119. https://doi.org/10.1093/eurheartj/ehv317
2. Vinke P, Jansen SM, Witkamp RF, van Norren K. Increasing quality of life in pulmonary arterial hypertension: is there a role for nutrition? Heart Fail Rev 2018;23:711-722. https://doi.org/10.1007/s10741-018-9717-9
3. Kwant CT, Ruiter G, Vonk Noordegraaf A. Malnutrition in pulmonary arterial hypertension: a possible role for dietary intervention. Curr Opin Pulm Med 2019;25:405-409. https://doi.org/10.1097/MCP.0000000000000608
4. Luo D, Xie N, Yang Z, Zhang C. Association of nutritional status and mortality risk in patients with primary pulmonary hypertension. Pulm Circ 2022;12:e12018. https://doi.org/10.1002/pul2.12018
5. Kubota K, Miyanaga S, Iwatani N, et al. Geriatric Nutritional risk index is associated with prognosis in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Circ Rep 2020;2:372-377. https://doi.org/10.1253/circrep.CR-20-0046
6. Snipelisky D, Jentzer J, Batal O, Dardari Z, Mathier M. Serum albumin concentration as an independent prognostic indicator in patients with pulmonary arterial hypertension. Clin Cardiol 2018;41:782-787. https://doi.org/10.1002/clc.22954
7. Ignacio de Ulíbarri J, González Madroño A, de Villar NGP, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 2005;20:38-45.
8. Benza RL, Kanwar MK, Raina A, et al. Development and validation of an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, for use in patients with pulmonary arterial hypertension. Chest 2021;159:337-346. https://doi.org/10.1016/j.chest.2020.08.2069
9. Benza RL, Gomberg Maitland M, Elliott CG, et al. Predicting survival in patients with pulmonary arterial hypertension: The REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest 2019;156:323-337. https://doi.org/10.1016/j.chest.2019.02.004
10. Sze S, Pellicori P, Kazmi S, et al. Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: a comparison with body mass index. JACC Heart Fail 2018;6:476-486. https://doi.org/10.1016/j.jchf.2018.02.018
11. Callejo M, Barberá JA, Duarte J, Perez Vizcaino F. Impact of nutrition on pulmonary arterial hypertension. Nutrients 2020;12:169. https://doi.org/10.3390/nu12010169
12. Vinke P, Koudstaal T, Muskens F, et al. Prevalence of micronutrient deficiencies and relationship with clinical and patient-related outcomes in pulmonary hypertension types I and IV. Nutrients 2021;13:3923. https://doi.org/10.3390/nu13113923
13. Ballmer PE. Causes and mechanisms of hypoalbuminaemia. Clin Nutr 2001;20:271-273. https://doi.org/10.1054/clnu.2001.0439
14. Zhou C, Townsley MI, Alexeyev M, Voelkel NF, Stevens T. Endothelial hyperpermeability in severe pulmonary arterial hypertension: role of store-operated calcium entry. Am J Physiol Lung Cell Mol Physiol 2016;311:560-569. https://doi.org/10.1152/ajplung.00057.2016
15. Liu Y, Coresh J, Eustace JA, et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA 2004;291:451-459. https://doi.org/10.1001/jama.291.4.451
16. Kalantar Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004;43:1439-1444. https://doi.org/10.1016/j.jacc.2003.11.039
17. Al-Naamani N, Palevsky HI, Lederer DJ, et al. ASA-STAT study group. Prognostic significance of biomarkers in pulmonary arterial hypertension. Ann Am Thorac Soc 2016;13:25-30. https://doi.org/10.1513/AnnalsATS.201508-543OC
18. Alwarawrah Y, Kiernan K, MacIver NJ. Changes in nutritional status impact immune cell metabolism and function. Front Immunol 2018;9:1055. https://doi.org/10.3389/fimmu.2018.01055
19. Cohen S, Danzaki K, MacIver NJ. Nutritional effects on T-cell immunometabolism. Eur J Immunol 2017;47:225-235. https://doi.org/10.1002/eji.201646423
20. Kawamoto A, Kato T, Minamino Muta E, Okano Y, Shioi T, Kimura T. Relationships between nutritional status and markers of congestion in patients with pulmonary arterial hypertension. Int J Cardiol 2015;187:27-28. https://doi.org/10.1016/j.ijcard.2015.03.354