Relationship between CONUT score and mortality in patients with pulmonary arterial hypertension

Abstract

Purpose: Data about the association of malnutrition with prognosis in pulmonary arterial hypertension (PAH) is limited. This study aims to evaluate the relationship of Controlling Nutritional Status (CONUT) score with long-term mortality in PAH. Materials and methods: All consecutive patients newly diagnosed with PAH between 2013 and 2020 were evaluated. CONUT score at diagnosis was calculated through total lymphocyte, albumin and total cholesterol levels. Primary outcome was long-term all-cause mortality. Patients were followed up for 62 (31.3-91.5) months. Results: 92 patients (mean age=43.9±15.7 years, 65.2% women) were included. 37% of the patients had any degree of malnutrition according to CONUT score (≥2). Patients without malnutrition were significantly more in the low-risk categories of risk stratification tools (44.8% vs 17.6% according to ESC/ERS guideline, p=0.03; 70.7% vs 35.3% and 70.7% vs 32.4% according to REVEAL 2.0 and REVEAL Lite 2, p<0.01 for both). In multivariate analysis, CONUT score predicted all-cause mortality (HR:1.51, 95% CI:1.01-1.52, p=0.03) independently after adjustment with ESC/ERS guideline risk score. Conclusion: CONUT score is independently associated with worse outcome in PAH patients and may indicate severe disease in this patient group.

Keywords

• Pulmonary arterial hypertension
• malnutrition
• controlling nutritional status score
• mortality

Pulmoner arteriyel hipertansiyonlu hastalarda nütrisyonel durum kontrolü (CONUT) skorunun mortalite ile ilişkisi

Abstract

Amaç: Birçok kronik hastalıkta olumsuz sonuçlarla ilişkili olduğu gösterilen malnütrisyonun, pulmoner arteriyel hipertansiyonda (PAH) prognoz ile ilişkisi net değildir. Bu çalışmada, PAH hastalığında Nütrisyonel Durum Kontrolü (CONUT) skoru ile uzun dönem mortalite arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve yöntem: 2013 ve 2020 tarihleri arasında PAH tanısı alan tüm ardışık hastalar retrospektif olarak incelendi. Tanı anındaki CONUT skoru; toplam lenfosit sayısı, albümin ve total kolesterol düzeyleri ile hesaplandı. Birincil sonlanım uzun dönem tüm nedenlere bağlı mortalite olarak belirlendi. Hastalar 62 (31,3-91,5) ay takip edildi. Bulgular: Çalışmaya 92 hasta dahil edildi. Ortalama yaşı 43,9±15,7 olan hasta grubunun %65,2’si kadındı. Hastaların %37’sinde CONUT skoruna göre herhangi bir derecede malnütrisyon mevcuttu (CONUT skoru ≥2). Malnütrisyon tespit edilmeyen hastalar, risk değerlendirme skorlarına göre düşük risk kategorisinde anlamlı olarak daha fazla yer almaktaydı (ESC/ERS kılavuzu risk skorlama sistemine göre %44,8’e karşı %17,6, p=0,03; REVEAL 2.0 risk sınıflamasına göre %70,7’ye karşı %35,3, p<0,01; REVEAL Lite 2 risk sınıflamasına göre %70,7’ye karşı %32,4, p<0,01). Çok değişkenli analizde, ESC/ERS kılavuzu risk skoru ile düzeltme yapıldıktan sonra, CONUT skoru (HR:1,51, 95% CI:1,01-1,52, p=0,03) uzun dönem tüm nedenlere bağlı mortaliteyi bağımsız olarak öngördürmekteydi. Sonuç: CONUT skoru, PAH'lı hastalarda kötü prognoz ile ilişkilidir ve bu hasta grubunda hastalığın şiddetini gösterebilir.

Keywords

• Pulmoner arteriyel hipertansiyon
• malnütrisyon
• nütrisyonel durum kontrolü skoru
• mortalite

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