Markers of malnutrition, inflammation and tissue remodeling are associated with one-year outcomes in patients with advanced heart failure
Kamila Kurkiewicz, Mariusz Gąsior, Bożena Szyguła‐Jurkiewicz
Abstract
INTRODUCTION: A number of predictive models and biomarkers are used to assess outcomes in patients with advanced heart failure (HF). OBJECTIVES: We sought to evaluate whether markers of malnutrition, inflammation, and tissue remodeling are associated with 1‑year mortality in patients with advanced HF. PATIENTS AND METHODS: We analyzed 200 consecutive patients with advanced HF. We assessed markers of inflammation and malnutrition, such as the neutrophil percentage‑to-albumin ratio (NPAR), the advanced lung cancer inflammation index (ALI), and the level of high‑sensitivity C-reactive protein (hsCRP). We also evaluated the level of tenascin‑C (TNC), as well as known markers of HF, such as N‑terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and bilirubin. Receiver operating characteristic (ROC) and Kaplan-Meier survival analyses were performed to evaluate the association of each parameter with 1‑year mortality. RESULTS: The median (interquartile range) age of the patients was 58 (51-64) years. The independent predictors of death were ALI (odds ratio [OR], 0.966; 95% CI, 0.941-0.992; P = 0.01) and NPAR (OR, 1.373; 95% CI, 1.126-1.674; P = 0.002), as well as serum levels of TNC (OR, 1.04; 95% CI, 1.020-1.050; P <0.001), hsCRP (OR, 1.187; 95% CI, 1.037-1.360; P = 0.01), NT‑ proBNP (OR, 1.110; 95% CI, 1.100-1.200; P = 0.02), creatinine (OR, 1.034; 95% CI, 1.013-1.055; P = 0.001), and bilirubin (OR, 1.079; 95% CI, 1.014-1.149; P = 0.02). The ROC analysis indicated a good discriminatory power of TNC (area under the curve [AUC] = 0.807), NT‑ proBNP (AUC = 0.760), hsCRP (AUC = 0.706), ALI (AUC = 0.749), and NPAR (AUC = 0.785) in predicting mortality during the 1‑year follow up. CONCLUSIONS: Our study demonstrated that a decreased ALI value, increased NPAR value, as well as elevated serum concentrations of TNC, NT‑proBNP, hsCRP, creatinine, and bilirubin are associated with 1‑year mortality in patients with advanced HF.