Objectives

To date, assessment of nutritional and frailty status in patients undergoing surgical aortic valve replacement remains unclear. This study aimed to assess the effect of geriatric nutritional risk index (GNRI) and Rockwood clinical frailty scale (CFS) on short-term and mid-term survival in patients who underwent surgical aortic valve replacement for aortic stenosis.

Methods

In total, 219 patients who underwent aortic valve replacement for aortic stenosis between Jan 1 2011 and Dec 31 2018 were retrospectively monitored in a single center. Mid-term survival was assessed using Kaplan–Meier analysis. Logistic and Cox regression analyses were performed to detect independent predictors for early and mid-term mortality. Follow-up was 97.7% complete, and a GNRI score ≤ 98 denoted malnutrition.

Results

In the univariable analysis, GNRI [odds ratio (OR) 0.91, 95% confidence interval (CI), 0.86–0.96, p < 0.001] and CFS (OR 2.00 95% CI 1.38–2.94, p < 0.001) were identified as significant risk factors for in-hospital mortality. Mid-term survival was significantly decreased in patients with malnutrition (3 and 5 year survival rates 83.9 and 76.9%, respectively, p < 0.001). Mid-term freedom from major cardiac and cerebrovascular events was significantly decreased in patients with malnutrition (p = 0.039). The CFS (hazard ratio 1.78) and GNRI (hazard ratio 0.95) were independent risk factors for mid-term survival in the univariable and multivariable analyses, respectively.

Conclusions

A lower GNRI is associated with poor mid-term mortality and major cardiac and cerebrovascular events after surgical aortic valve replacement. A lower CFS score is associated with unfavorable mid-term outcomes.

中文翻译：

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营养不良和虚弱状态对外科主动脉瓣置换术的影响

目标

迄今为止，对接受外科主动脉瓣置换术的患者的营养和虚弱状态的评估仍不清楚。本研究旨在评估老年营养风险指数 (GNRI) 和 Rockwood 临床衰弱量表 (CFS) 对接受外科主动脉瓣置换术治疗主动脉瓣狭窄患者的短期和中期生存率的影响。

方法

总共有 219 名在 2011 年 1 月 1 日至 2018 年 12 月 31 日期间因主动脉瓣狭窄而接受主动脉瓣置换术的患者在一个中心进行了回顾性监测。使用 Kaplan-Meier 分析评估中期生存率。进行 Logistic 和 Cox 回归分析以检测早期和中期死亡率的独立预测因子。随访完成率为 97.7%，GNRI 评分≤98 表示营养不良。

结果

在单变量分析中，GNRI [优势比 (OR) 0.91, 95% 置信区间 (CI), 0.86–0.96, p  < 0.001] 和 CFS (OR 2.00 95% CI 1.38–2.94, p  < 0.001) 被确定为显着院内死亡的危险因素。营养不良患者的中期生存率显着下降（3 年和 5 年生存率分别为 83.9% 和 76.9%，p  < 0.001）。营养不良患者的中期无主要心脑血管事件显着降低（p  = 0.039）。在单变量和多变量分析中，CFS（风险比 1.78）和 GNRI（风险比 0.95）分别是中期生存的独立危险因素。

结论

较低的 GNRI 与手术主动脉瓣置换术后较差的中期死亡率和主要的心脑血管事件相关。较低的 CFS 评分与不利的中期结果相关。