Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

CONUT评分与脑梗死预后及TOAST分型关系的研究*

目的：研究CONUT评分与脑梗死预后及TOAST分型的关系。方法：对496例脑梗死患者进行CONUT评分及TOAST分型,分析高CONUT评分组与低CONUT组发病三个月病残率及复发率的差异,分析TOAST分型各型CONUT评分的差异。结果：高CONUT评分组病残率和复发率比低CONUT组高,差异都有统计学意义(P<0.05)。按照TOAST分型,以心源性栓塞型(CE型)脑梗死患者CONUT评分最高,差异有统计学意义(P<0.05)。结论：CONUT评分可以作为脑梗死预后判断的指标。在脑梗死TOAST分型中,CE型脑梗死患者CONUT评分最高。     

Impacts of geriatric nutritional risk index on prognosis of patients with non-ST-segment elevation acute coronary syndrome: Results from an observational cohort study in China

Background and aimsIt is recognized that malnutrition increases risk of worse prognosis in patients with various diseases. The present study investigated if poor nutritional status predicts adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).Methods and resultsThe study enrolled 2299 patients (mean age: 60.01 ± 8.95 years; 71.8% male) with NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. The entire cohort was divided into training set (n = 1519) and testing set (n = 780) at a ratio of approximate 2 : 1. Nutritional status was assessed by geriatric nutritional risk index (GNRI). The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and any revascularization. Multivariate Cox analysis showed that GNRI significantly associated with primary endpoint, independent of other risk factors [hazard ratio (HR) 1.159 per 1-point decrease of GNRI, 95% confidence interval (CI) 1.130–1.189, p < 0.001]. The addition of GNRI to a baseline model had an incremental effect on the predictive value for adverse prognosis in training set [AUC: from 0.821 to 0.873, p < 0.001; category-free net reclassification improvement (NRI): 0.313, p < 0.001; integrated discrimination improvement (IDI): 0.108, p < 0.001]. The incremental effect of GNRI was further validated and confirmed in testing set.ConclusionLower GNRI is a significant predictor of adverse prognosis in patients with NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether nutritional interventions have a positive impact on improving clinical prognosis.     

Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

There were few studies assessed the postoperative sarcopenia in patients with cancers. The objective of present study was to assess whether postoperative development of sarcopenia could predict a poor prognosis in patients with adenocarcinoma of esophagogastric junction, (AEG) and upper gastric cancer (UGC).

预后营养指数和控制营养状态在乳腺癌中的研究进展

乳腺癌已超过肺癌成为女性最常见的恶性肿瘤。虽然早期诊断率不断提高,但复发和转移仍然是有待解决的难题。因此,应寻找有效预测乳腺癌患者预后的标志物,针对不同患者采取个体化方案。有研究表明,癌症预后在某种程度上与营养炎症指标有关。术前预后营养指数（PNI）和控制营养状态（CONUT）是综合反映患者营养水平和炎症状态的两项指标。与其他癌种不同,乳腺癌的发病与营养状况有关,评分过高或过低均不利于乳腺癌患者的预后。本文就PNI及CONUT在乳腺癌中的研究进展进行综述。     

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording

BackgroundMalnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition.ObjectivesThe objective of the study was to evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and arrhythmic events on 24-h electrocardiography (ECG) Holter recording in patients without manifested arrhythmia.MethodsIn this retrospective analysis of 477 patients who underwent 24-h ECG Holter monitoring, PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1–2: mild risk of malnutrition, ≥3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups.ResultsTotal number of premature atrial contractions, premature ventricular contractions (PVCs), PVC burden, and incidence of paroxysmal atrial fibrillation (PAF) were significantly higher in patients within the lowest PNI tertile. Total number of PVCs, PVC burden, and incidence of PAF were significantly higher in patients with CONUT score ≥3. The cut-off value for PNI to predict the presence of PVC was defined as 39.41 using ROC curve analysis. The area under the curve was 0.650 (p < 0.001). Multivariate analysis showed that PNI was independent predictor of the presence of PVC and PAF. Also, CONUT score was independent predictor of the presence of PVC and PAF. Incidence of nonsustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups.ConclusionPoor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24-h ECG Holter recording in patients without manifested arrhythmia.     

Effects of malnutrition on length of stay in patients hospitalized in an acute psychiatric ward

Introduction

Psychiatric patients are considered at risk for malnutrition due to pharmacological treatments, lifestyle habits and the mental illness by itself. Even though metabolic risk factors have been related to worse outcomes in certain conditions, the evidence regarding the nutritional status and its impact on the length of stay in psychiatric inpatients is scarce. This study aims to characterize the nutritional status in acute psychiatric patients, to correlate it with the length of stay, and to find specific potential indicators of malnutrition.

Methods

Adult patients admitted to the Hospital Clínic of Barcelona acute psychiatric ward throughout a 1-year period were included in this cross-sectional study. Sociodemographic and clinical variables were registered, including length of stay and the nutritional status measured with the CONUT score.

Results

Malnutrition was observed in 42.5% of patients. Plasmatic transferrin saturation, protein and iron levels were inversely correlated with length of stay, having low iron levels an association with longer hospitalizations. The length of stay was not influenced by diagnosis or treatment. Negative correlations with the nutritional status were found in: BMI, cholesterol, triglycerides, albumin, total proteins, prealbumin, iron, lymphocytes and zinc levels, and transferrin saturation. The multivariate analysis showed a significant association for cholesterol and zinc levels, lymphocyte count, and BMI.

Conclusions

Our results suggest that nutritional status might influence the course of psychiatric admissions. Cholesterol and zinc levels, lymphocyte count, and BMI might be factors strongly associated with malnutrition. This consideration might allow the identification of profiles in which lifestyle interventions could be implemented.