N Pavone, F Cammertoni, P Bruno, G Cutrone, G A Chiariello, M Calabrese, M Grandinetti, M Nesta, E Marzetti, R Calvani, R Gambardella, A D Conserva, E Romagnoli, F Burzotta, M Massetti
{"title":"术前营养状况不良会影响心脏瓣膜手术的效果吗？","authors":"N Pavone, F Cammertoni, P Bruno, G Cutrone, G A Chiariello, M Calabrese, M Grandinetti, M Nesta, E Marzetti, R Calvani, R Gambardella, A D Conserva, E Romagnoli, F Burzotta, M Massetti","doi":"10.14283/jfa.2024.54","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.</p><p><strong>Objectives: </strong>To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.</p><p><strong>Design: </strong>Retrospective, single-center.</p><p><strong>Setting: </strong>Cardiac Surgery Unit, Fondazione Policlinico Universitario \"A. Gemelli\" IRCCS, Rome, Italy.</p><p><strong>Participants: </strong>448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.</p><p><strong>Measurements: </strong>Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.</p><p><strong>Results: </strong>Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.</p><p><strong>Conclusion: </strong>A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"13 4","pages":"501-506"},"PeriodicalIF":3.3000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does a Poor Preoperative Nutritional Status Impact outcomes of Heart Valve Surgery?\",\"authors\":\"N Pavone, F Cammertoni, P Bruno, G Cutrone, G A Chiariello, M Calabrese, M Grandinetti, M Nesta, E Marzetti, R Calvani, R Gambardella, A D Conserva, E Romagnoli, F Burzotta, M Massetti\",\"doi\":\"10.14283/jfa.2024.54\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.</p><p><strong>Objectives: </strong>To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.</p><p><strong>Design: </strong>Retrospective, single-center.</p><p><strong>Setting: </strong>Cardiac Surgery Unit, Fondazione Policlinico Universitario \\\"A. Gemelli\\\" IRCCS, Rome, Italy.</p><p><strong>Participants: </strong>448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.</p><p><strong>Measurements: </strong>Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.</p><p><strong>Results: </strong>Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.</p><p><strong>Conclusion: </strong>A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.</p>\",\"PeriodicalId\":51629,\"journal\":{\"name\":\"Journal of Frailty & Aging\",\"volume\":\"13 4\",\"pages\":\"501-506\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Frailty & Aging\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14283/jfa.2024.54\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Frailty & Aging","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14283/jfa.2024.54","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Does a Poor Preoperative Nutritional Status Impact outcomes of Heart Valve Surgery?
Background: Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.
Objectives: To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.
Design: Retrospective, single-center.
Setting: Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Participants: 448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications.
Measurements: Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival.
Results: Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group.
Conclusion: A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.
期刊介绍：
The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons. The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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