Impact of malnutrition on long-term mortality in critical patients with atrial fibrillation

Background Malnutrition has been shown to be related to adverse clinical outcomes in patients with cardiovascular diseases. However, the association of nutritional state and long-term all-cause mortality in critical patients with atrial fibrillation(AF) remains unknown. Methods Critical patients who complicated with AF in the third edition of the Medical Information Mart in Critical Care(MIMIC-Ⅲ) registry were enrolled into this study. The primary endpoint was long-term all-cause mortality. Patients’ nutrition status was tested by 4 screening tools, which included controlling nutritional status(CONUT), prognostic nutritional index(PNI), geriatric nutritional risk index(GNRI) scores and body mass index(BMI). Kaplan-Meier and Cox proportional analyses were used to investigate the association between nutritional state and 4-year all-cause mortality. Results A total of 630 critical patients with AF(72.0 ± 11.2 years, male 36.5%) were included in this study, and the 4-year all-cause mortality rate was42.5%(n=268). It was up to 68.5% patients with malnutrition according to CONUT score. Kaplan-Meier and multivariate Cox proportional regression showed that the moderate to severe malnutrition was independent indicator for long-term mortality based on CONUT score(moderate vs. normal, adjusted hazard ratio [HR]: 1.78, 95% CI: 1.22-2.62; Severe vs. normal adjusted HR: 2.18, 95% CI: 1.52-3.15, respectively]. Furthermore, the CONUT score showed the best effect of predicting worsen long-term prognosis among 4 malnutrition screening tools(The Area under cure [AUC] of CONUT vs. PNI vs. GNRI vs. BMI = 0.656 vs. 0.643 vs. 0.617 vs. 0.552). Conclusions Malnutrition is a common complication and significantly affects the prognosis of critical patients with AF, and CONUT score is an optimal screening tool to assess the nutritional status and long-term prognosis in these patient. [S Chin J Cardiol 2023;24(3):121-132]