ISSN 2996-8215
International Journal of Cardiology | Vol. 13, No. 5, May 2022 | pp. 33–40
DOI: 10.46882/2022/IJC/000158
Original Research Article
Objective Assessment of Chronic Malnutrition via the CONUT Score for Predicting Three-Year Mortality in Dilated Cardiomyopathy
Maria G. Silva¹, Joao P. Santos¹, António F. Ribeiro²
¹Department of Internal Medicine and Cardiology, University Hospital of Coimbra, Coimbra, Portugal
²Division of Cardiovascular Medicine, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
Abstract:
Advanced heart failure from dilated cardiomyopathy (DCM) induces progressive metabolic derangements, culminating in systemic cachexia. Objective nutritional parameters are rarely integrated into standard outpatient risk profiles. This prospective cohort study evaluated the prevalence of subclinical malnutrition using the Controlling Nutritional Status (CONUT) score and determined its long-term prognostic significance in stable DCM outpatients. We evaluated 185 stable DCM patients presenting with an LVEF less than 40%. The CONUT index was derived from baseline serum albumin, total cholesterol, and absolute lymphocyte counts, stratifying patients into normal or high nutritional risk categories. The primary clinical endpoint was a composite of all-cause mortality or urgent heart transplantation over 36 months. High baseline nutritional risk (CONUT score greater than or equal to 5) was present in 27.0% of the cohort. Over a median follow-up of 34 months, the primary endpoint was reached in 54 patients (29.2%). Survival curves showed a significantly reduced event-free survival rate in the high nutritional risk group compared to the low-score cohort (44.0% vs. 81.5%, log-rank p < 0.001). After adjusting for age, NYHA class, baseline LVEF, and NT-proBNP levels, multivariable Cox regression confirmed that a CONUT score greater than or equal to 5 was an independent predictor of long-term mortality transitions (hazard ratio: 2.15, 95% CI: 1.28–3.55, p = 0.003). Subclinical malnutrition, objectively assessed via the CONUT score, is common in stable dilated cardiomyopathy and independently predicts long-term mortality.
Keywords: Dilated cardiomyopathy, Malnutrition, CONUT score, Heart failure, Cachexia, Prognosis
Received: February 14, 2022; Revised: March 28, 2022; Accepted: April 14, 2022; Published: May 22, 2022