Introduction: Geriatric nutritional risk index (GNRI) is one of the established parameters for the evaluation of nutritional status of patients. Low GNRI is related with mortality in patients with heart failure. Although polyunsaturated fatty acids (PUFAs), particularly omega-6 PUFAs (including dihomo-gamma-linolenic acid [DGLA] and arachidonic acid [AA]), are associated with long-term mortality in patients with acute decompensated heart failure (ADHF), the clinical significance of PUFAs in various nutrition statuses remains unclear. We investigated whether low PUFA levels predict poor prognosis of patients with ADHF, regardless of the GNRI.
Methods: We enrolled 267 consecutive patients with ADHF admitted to the cardiac intensive care unit in our hospital from April 2012 to March 2014. Patients with malignant diseases, end-stage renal diseases, and patients who had received eicosapentaenoic acid (EPA) therapy were excluded. GNRI and fasting PUFA (DGLA, AA, EPA, and docosahexaenoic acid [DHA]) levels were measured within 24 hours after admission.
Results: During the 22.6-month mean follow-up period, 62 patients died. The GNRI and individual PUFA levels were significantly lower in the non-survivor group compared with the survivor group (all p < 0.05). Kaplan-Meier survival analysis showed that low GNRI and individual PUFA levels were associated with all-cause mortality (all p < 0.05). Furthermore, even in the lower GNRI group (GNRI < 90.7), low DGLA, but not AA, EPA, and DHA, levels were still associated with all-cause mortality (p = 0.04, Figure). Multivariable cox regression analysis showed that low DGLA, AA, and DHA levels were predictors for all-cause mortality independent of the GNRI (all p < 0.01).
Conclusion: Decreased levels of PUFAs, especially DGLA, in patients with ADHF were significantly associated with long-term mortality, independent of the GNRI.