Impact of malnutrition on long-term mortality in critical patients with atrial fibrillation

XIONG Er-feng; XIE Han-bin; ZHANG Yan-ling; DENG Zhi-zhao; SUN Guo-liang; YUAN Dong-dong

摘要：Background Malnutrition has been shown to be related to adverse clinical outcomes in patients with cardiovas-cular diseases.However,the association of nutritional state and long-term all-cause mortality in critical patients with atrial fibrillation(AF)remains unknown.Methods Critical patients who complicated with AF in the third edition of the Medical Information Mart in Critical Care(MIMIC-Ⅲ)registry were enrolled into this study.The pri-mary endpoint was long-term all-cause mortality.Patients'nutrition status was tested by 4 screening tools,which in-cluded controlling nutritional status(CONUT),prognostic nutritional index(PNI),geriatric nutritional risk index(GNRI)scores and body mass index(BMI).Kaplan-Meier and Cox proportional analyses were used to investigate the association between nutritional state and 4-year all-cause mortality.Results A total of 630 critical patients with AF(72.0±11.2 years,male 36.5％)were included in this study,and the 4-year all-cause mortality rate was 42.5％(n=268).It was up to 68.5％patients with malnutrition according to CONUT score.Kaplan-Meier and multi-variate Cox proportional regression showed that the moderate to severe malnutrition was independent indicator for long-term mortality based on CONUT score(moderate vs.normal,adjusted hazard ratio[HR]:1.78,95％CI:1.22-2.62;Severe vs.normal adjusted HR:2.18,95％CI:1.52-3.15,respectively].Furthermore,the CONUT score showed the best effect of predicting worsen long-term prognosis among 4 malnutrition screening tools(The Area under cure[AUC]of CONUT vs.PNI vs.GNRI vs.BMI=0.656 vs.0.643 vs.0.617 vs.0.552).Conclusions Malnu-trition is a common complication and significantly affects the prognosis of critical patients with AF,and CONUT score is an optimal screening tool to assess the nutritional status and long-term prognosis in these patient.[S Chin J Cardiol 2023;24(3):121-132]