Background: Nutritional status on admission is an independent predictor of mortality in patients with heart failure (HF). CONUT (CONtrolling NUTritional) score is an index calculated from the following factors; serum albumin level, total peripheral lymphocyte count and total cholesterol concentration, and has been reported to well represent nutritional status in chronic HF patients. However, in hospitalized patients with acute HF (AHF), there has been limited evidence about a prognostic value of nutritional status at discharge.
Methods: This study included 365 consecutive patients without regular hemodialysis who were urgently hospitalized due to AHF and discharge alive. They were divided into 2 groups depending on CONUT score at discharge with cut-off of 3 point, referring to previous reports. The primary endpoint of this study was a combination of cardiovascular (CV) death and readmission due to worsening of HF.
Results: During 380 days of median follow-up period, Kaplan-Meier analysis showed a higher combined outcome in high-CONUT at discharge (Log-rank test: p<0.001). In contrast, high-CONUT on admission did not have a significant difference in the primary outcome after discharge, compared to normal-CONUT on admission (p=0.07, Figure 1). Cox regression analysis showed that body mass index (BMI) and CONUT score at discharge were independent predictors for adverse CV events after discharge (Hazard ratio (HR): 0.93 (95%Confidence interval (CI): 0.86-0.99); HR: 1.86 (95%CI: 1.02-3.40), respectively). Additionally, patients with high baseline CONUT had similar outcome to normal baseline CONUT, if CONUT improved to normal range during hospitalization (Log-rank test: p=0.001, Figure 2).
Conclusions: Nutritional status in AHF patients at discharge, but not at admission, was associated with CV events after discharge. Restoration of nutritional status during hospitalization may improve clinical performance in AHF patients.