Prevalence and Prognostic Significance of Malnutrition in Patients with Type B Aortic Dissection Undergoing Endovascular Repair

Ting Zhou; Songyuan Luo; Wenhui Lin; Yinghao Sun; Jizhong Wang; Jitao Liu; Yuan Liu; Wenhui Huang; Fan Yang; Jie Li; Jianfang Luo

doi:10.31083/j.rcm2507249

Prevalence and Prognostic Significance of Malnutrition in Patients with Type B Aortic Dissection Undergoing Endovascular Repair

Rev Cardiovasc Med. 2024 Jul 5;25(7):249. doi: 10.31083/j.rcm2507249. eCollection 2024 Jul.

Authors

Ting Zhou¹, Songyuan Luo², Wenhui Lin², Yinghao Sun², Jizhong Wang³, Jitao Liu², Yuan Liu², Wenhui Huang², Fan Yang⁴, Jie Li², Jianfang Luo²

Affiliations

¹ Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510515 Guangzhou, Guangdong, China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510515 Guangzhou, Guangdong, China.
³ School of Medicine, South China University of Technology, 510641 Guangzhou, Guangdong, China.
⁴ Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.

Abstract

Background: Malnutrition is a poor prognostic factor in a wide range of diseases. Nevertheless, there is a lack of data investigating the association between malnutrition and outcomes of patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Therefore, the aim of the present study was to report the prevalence and clinical impact of malnutrition assessed by the controlling nutritional status (CONUT) score in TBAD patients undergoing TEVAR.

Methods: The retrospective study indicated that a total of 881 patients diagnosed with TBAD and treated with TEVAR from January 2010 to December 2017 were categorized into subgroups based on their CONUT score (low $\leq$ 5 vs. high $>$ 5). To assess the correlation between malnutrition and early and follow-up outcomes of TBAD patients, logistic and Cox regression analysis were utilized, incorporating inverse probability weighting.

Results: Malnutrition was present in 20.3% of patients according to the CONUT score. Multivariate logistic regression analysis revealed that pre-operative CONUT score modeled as a continuous variable was an independent risk factor for prolonged intensive care unit stay (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.17; p = 0.015), 30-day death (OR, 1.43; 95% CI, 1.19-1.72; p $<$ 0.001), delirium (OR, 1.11; 95% CI, 1.01-1.23; p = 0.035) and acute kidney injury (OR, 1.09; 95% CI, 1.01-1.16; p = 0.027). During a median follow-up of 70.8 (46.1-90.8) months, 102 (11.8%) patients died (high CONUT group: 21.8% vs. low CONUT group: 9.0%; p $<$ 0.001). Multivariable Cox proportional-hazards models showed that malnutrition was an independent predictor for follow-up mortality (hazard ratio, 1.68; 95% CI, 1.11-2.53; p = 0.014). Results remained consistent across various sensitivity analyses.

Conclusions: Malnutrition assessed by the CONUT score could profoundly affect the early and follow-up prognosis in patients undergoing TEVAR. Routine pre-intervention nutritional evaluation might provide valuable prognostic information.

Keywords: controlling nutritional status score; malnutrition; outcomes; thoracic endovascular aortic repair; type B aortic dissection.

Grants and funding

Financial backing for the research, writing, and publication of this article was recognized by the authors, including the National Natural Science Foundation of China (82200519); Natural Science Foundation of Guangdong Province, China (2022A1515010897) and Medical Scientific Research Foundation of Guangdong Province, China (A2021348). The investigation’s structure, data gathering, analysis, and the interpretation of results were not influenced by the funding entities.