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A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support

1
Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
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Department of Clinical Engineering, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku, Tokyo 113-8431, Japan
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Department of Clinical Engineering, Juntendo University Shizuoka Hospital, 1129 Nagaoka Izunokuni-city, Shizuoka 410-2295, Japan
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Department of Clinical Engineering, Juntendo University Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo 177-8521, Japan
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Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka Izunokuni-city, Shizuoka 410-2295, Japan
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Department of Cardiovascular Medicine, Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo 177-8521, Japan
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Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(6), 1420; https://doi.org/10.3390/nu11061420
Received: 27 May 2019 / Revised: 18 June 2019 / Accepted: 20 June 2019 / Published: 24 June 2019
Background: A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have previously proposed a novel nutritional index, which can be calculated using serum levels of triglycerides, total cholesterol, and body weight (TCBI). In this study, to expand the application of TCBI for critical patients, we investigated the usefulness of TCBI to predict prognosis in hemodynamically unstable patients with percutaneously implantable mechanical circulatory support (MCS) devices in the ICU. Patients and Methods: This is a retrospective analysis of a multicenter registry consisting of three Juntendo University hospitals in Japan involving patients who received MCS devices, including intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (VA-ECMO), between 2012 and 2016 (n = 439). The median follow-up period was 298 days. Results: Spearman’s correlation coefficient between TCBI and the geriatric nutritional risk index (GNRI) was 0.44 (p < 0.0001), indicating a moderate positive correlation for these two variables. Unadjusted Kaplan–Meier analysis demonstrated reduced risks of all-cause and cardiovascular mortalities in patients with higher tertiles of TCBI. Furthermore, adjusted multivariate Cox proportional hazard analyses revealed that the highest tertile TCBI was an independent predictor for the reduced risk of all-cause mortality (hazard ratio (HR): 0.22, 95% confidence interval: 0.10–0.48, p < 0.0001) and cardiovascular mortality (0.20, 0.09–0.45, p < 0.0001). Conclusion: A novel and simple to calculate nutritional index, TCBI, can be applicable as a prognostic indicator in hemodynamically unstable patients requiring MCS devices. View Full-Text
Keywords: nutritional index; intensive care unit; mechanical circulatory support; prognostic indicator nutritional index; intensive care unit; mechanical circulatory support; prognostic indicator
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Minami-Takano, A.; Iwata, H.; Miyosawa, K.; Kubota, K.; Kimura, A.; Osawa, S.; Shitara, M.; Okazaki, S.; Suwa, S.; Miyauchi, K.; Sumiyoshi, M.; Amano, A.; Daida, H. A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support. Nutrients 2019, 11, 1420.

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