Malnutrition and outcomes in cardiac surgery

The aim of this study was to investigate the relationship between malnutrition and long-term survival in patients that underwent cardiopulmonary bypass (CPB). The principal question was to assess how the malnutrition contributes to the risk of postoperative mortality in cardiac patients. Materials and Methods. This study analyzed the long-term survival data of mixed cohort of 1187 cardiac patients previously enrolled in a prospective observational study of nutritional screening in cardiac surgery (NCT01366807). Patients were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), the Mini Nutritional Assessment (MNA), and the Short Nutritional Assessment Questionnaire (SNAQ), Nutritional status was assessed using the Subjective Global Assessment. In total, 449 (37.8%) patients were lost to follow-up after hospitalization, while for the remaining participants, the overall 8-year survival was 68% [95% confidence interval (CI), 59–76] and 77% [95% CI, 73–80] (log-rank, p=0.12) in patients with and without malnutrition risk, respectively. Statistically significant differences in survival were found during the 3-year follow-up of patients with HVD: 83% [95% CI, 74–92] with malnutrition vs. 93% [95% CI, 90–96] without malnutrition (log-rank, p=0.03). The final multivariate Cox regression model revealed logistic EuroSCORE (hazard ratio (HR) 1.337, 95% CI 1.110–1.612), CPB time<110.5 minutes (HR 0.463, 95% CI 0.255–0.842), preoperative albumin (HR 0.799, 95% CI 0.691–0.924), and C-reactive protein (HR 1.106, 95% CI 1.018–1.202) as independent predictors of 3-year survival: In conclusion, preoperative malnutrition is not associated with 8-year mortality in mixed cardiac surgery cohort. However, it may be associated with a worse 3-year outcomes in patients with HVD. These data are the first reflecting the relationship between malnutrition and long term outcome among cardiac patients and may be useful for researchers, conducting studies on nutrition in cardiology for sample size calculation and estimation of clinically relevant end points in future.