Malnutrition diagnosed by controlling nutrition status is a negative predictor of life prognosis in aortic arch aneurysm patients treated with thoracic endovascular aneurysm repair
Restricted accessResearch articleFirst published online February, 2020
Malnutrition diagnosed by controlling nutrition status is a negative predictor of life prognosis in aortic arch aneurysm patients treated with thoracic endovascular aneurysm repair
Controlling Nutritional Status (CONUT) is a useful screening tool for malnutrition in patients with various diseases; however, how CONUT-diagnosed malnutrition affects patients with aortic arch aneurysm is unknown. This study aimed to reveal the utility of CONUT for detecting the patients with high-risk aortic arch aneurysm with malnutrition.
Methods
Sixty patients treated for aortic arch aneurysms with elective thoracic endovascular aneurysm repair from 2009 to 2015 were retrospectively analyzed at a single institution. Preoperative nutrition status was evaluated by CONUT, and a CONUT score ≥ 3 was defined as malnutrition. The influence of malnutrition on the patients’ overall survival, aneurysm-related death-free rates, and prevalence of re-interventions were also analyzed.
Results
Twenty-three patients were diagnosed with malnutrition. Overall survival was significantly lower in the malnutrition group (P = 0.0036). The multivariate Cox proportional hazard analysis revealed that age (P< 0.0001) and malnutrition (P= 0.0457) were negative predictors of overall survival. Conversely, the two groups did not differ significantly in aneurysm-related death-free rates (P= 0.7879) and the prevalence of re-interventions (P= 0.7879).
Conclusions
Malnutrition diagnosed by CONUT as well as age is a negative predictor of survival prognosis in patients with aortic arch aneurysm.
KimDHKimCAPlacideS, et al.
Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review. Ann Intern Med2016;
165: 650–660.
2.
LinHSWattsJNPeelNM, et al.
Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr2016;
16: 157.
3.
RajabaliNRolfsonDBagshawSM.Assessment and utility of frailty measures in critical illness, cardiology, and cardiac surgery. Can J Cardiol2016;
32: 1157–1165.
4.
ZygaSChristopoulouGMalliarouM.Malnutrition-inflammation-atherosclerosis syndrome in patients with end-stage renal disease. J Renal Care2011;
37: 12–15.
5.
MorisakiKMatsumotoTMatsubaraY, et al.
Prognostic factor of the two-year mortality after revascularization in patients with critical limb ischemia. Vascular2016;
25: 123–129.
6.
IidaOSogaYYamauchiY, et al.
Clinical efficacy of endovascular therapy for patients with critical limb ischemia attributable to pure isolated infrapopliteal lesions. J Vasc Surg2013;
57: 974–981.
7.
BucholzEMKrumholzHAKrumholzHM.Underweight, markers of cachexia, and mortality in acute myocardial infarction: a prospective cohort study of elderly Medicare beneficiaries. PLoS Med2016;
13: e1001998.
8.
RenfroLALoupakisFAdamsRA, et al.
Body mass index is prognostic in metastatic colorectal cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database. J Clin Oncol Off J Am Soc Clin Oncol2016;
34: 144–150.
9.
BalakrishnanVS.Low BMI linked to worse colorectal cancer outcomes. Lancet Oncol2015;
16: e593.
10.
KuzuyaMIzawaSEnokiH, et al.
Is serum albumin a good marker for malnutrition in the physically impaired elderly?.Clin Nutrit2007;
26: 84–90.
11.
BharadwajSGinoyaSTandonP, et al.
Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Report2016;
4: 272–280.
12.
Ignacio de UlibarriJGonzalez-MadronoAde VillarNG, et al.
CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutricion Hospitalaria2005;
20: 38–45.
13.
IsekiYShibutaniMMaedaK, et al.
Impact of the preoperative controlling nutritional status (CONUT) score on the survival after curative surgery for colorectal cancer. PloS One2015;
10: e0132488.
14.
HiraharaNMatsubaraTHayashiH, et al.
Prognostic importance of controlling nutritional status in patients undergoing curative thoracoscopic esophagectomy for esophageal cancer. Am J Therapeut2018;
25: e524–e532.
15.
TanakaTSatoTYamashitaK, et al.
Effect of preoperative nutritional status on surgical site infection in colorectal cancer resection. Dig Surg2016;
34: 68–77.
16.
YoshidaNBabaYShigakiH, et al.
Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg2016;
40: 1910–1917.
17.
NochiokaKSakataYTakahashiJ, et al.
Prognostic impact of nutritional status in asymptomatic patients with cardiac diseases: a report from the CHART-2 Study. Circ J2013;
77: 2318–2326.
18.
NarumiTArimotoTFunayamaA, et al.
Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol2013;
62: 307–313.
19.
BastaGChatzianagnostouKParadossiU, et al.
The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Int J Cardiol2016;
221: 987–992.
20.
AntoniouGAEl SakkaKHamadyM, et al.
Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg2010;
39: 683–690.
21.
InoueKOnoharaTMikasaK, et al.
Early-phase wound healing and long-term outcomes of a selective endovascular-first approach for treating Rutherford 5 critical limb ischemia with infrainguinal lesions. Surg Today2016;
46: 1301–1309.
22.
FillingerMFGreenbergRKMcKinseyJF, et al.
Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg2010;
52: 1022–1033.
23.
StrattonRJKingCLStroudMA, et al.
Universal screening tool predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr2006;
95: 325–330.
24.
GalyfosGGeropapasGIKerasidisS, et al.
The effect of body mass index on major outcomes after vascular surgery. J Vasc Surg2016;
65: 1193–1207.
25.
GerrietsVAMacIverNJ.Role of T cells in malnutrition and obesity. Front Immunol2014;
5: 379.
26.
SchatzIJMasakiKYanoK, et al.
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet2001;
358: 351–355.
27.
Weverling-RijnsburgerAWBlauwGJLagaayAM, et al.
Total cholesterol and risk of mortality in the oldest old. Lancet1997;
350: 1119–1123.
28.
RodriguezFHarringtonRA.Cholesterol, cardiovascular risk, statins, PCSK9 inhibitors, and the future of LDL-C lowering. Jama2016;
316: 1967–1968.
29.
DykerAGWeirCJLeesKR.Influence of cholesterol on survival after stroke: retrospective study. Bmj1997;
314: 1584–1588.
30.
HorwichTBHamiltonMAMaclellanWR, et al.
Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail2002;
8: 216–224.
31.
BeharSGraffEReicher-ReissH, et al.
Low total cholesterol is associated with high total mortality in patients with coronary heart disease. The Bezafibrate Infarction Prevention (BIP) Study Group. Eur Heart J1997;
18: 52–59.
32.
NakagomiASeinoYKohashiK, et al.
Effects of statin therapy on the production of monocyte pro-inflammatory cytokines, cardiac function, and long-term prognosis in chronic heart failure patients with dyslipidemia. Circ J2012;
76: 2130–2138.
33.
IwakoshiSIchihashiSItohH, et al.
Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft). J Vasc Surg2015;
62: 1473–1478.
34.
KurimotoYMaruyamaRUjihiraK, et al.
Thoracic endovascular aortic repair for challenging aortic arch diseases using fenestrated stent grafts from zone 0. Ann Thor Surg2015;
100: 24–33.
35.
De WaeleENguyenDDe BondtK, et al.
The CoCoS trial: caloric control in cardiac surgery patients promotes survival, an interventional trial with retrospective control. Clin Nutr2018;
37: 864–869.
