Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure
Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024060 |
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| author | Yi‐Kei Tse Chanchal Chandramouli Hang‐Long Li Si‐Yeung Yu Mei‐Zhen Wu Qing‐Wen Ren Yan Chen Pui‐Fai Wong Ko‐Yung Sit Daniel Tai‐Leung Chan Cally Ka‐Lai Ho Wing‐Kuk Au Xin‐Li Li Hung‐Fat Tse Carolyn S. P. Lam Kai‐Hang Yiu |
| author_facet | Yi‐Kei Tse Chanchal Chandramouli Hang‐Long Li Si‐Yeung Yu Mei‐Zhen Wu Qing‐Wen Ren Yan Chen Pui‐Fai Wong Ko‐Yung Sit Daniel Tai‐Leung Chan Cally Ka‐Lai Ho Wing‐Kuk Au Xin‐Li Li Hung‐Fat Tse Carolyn S. P. Lam Kai‐Hang Yiu |
| author_sort | Yi‐Kei Tse |
| collection | DOAJ |
| description | Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery. |
| first_indexed | 2024-04-10T04:35:52Z |
| format | Article |
| id | doaj.art-0b5d0702799a425fb49c1a67e46c0aeb |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T04:35:52Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0b5d0702799a425fb49c1a67e46c0aeb2023-03-10T04:02:36ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-05-01111010.1161/JAHA.121.024060Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart FailureYi‐Kei Tse0Chanchal Chandramouli1Hang‐Long Li2Si‐Yeung Yu3Mei‐Zhen Wu4Qing‐Wen Ren5Yan Chen6Pui‐Fai Wong7Ko‐Yung Sit8Daniel Tai‐Leung Chan9Cally Ka‐Lai Ho10Wing‐Kuk Au11Xin‐Li Li12Hung‐Fat Tse13Carolyn S. P. Lam14Kai‐Hang Yiu15Division of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaNational Heart Centre Singapore SingaporeDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaDivision of Cardiology Department of Medicine The University of Hong KongQueen Mary Hospital Hong Kong ChinaDivision of Cardiothoracic Surgery Department of Surgery The University of Hong KongQueen Mary Hospital Hong Kong ChinaDivision of Cardiothoracic Surgery Department of Surgery The University of Hong KongQueen Mary Hospital Hong Kong ChinaDivision of Cardiothoracic Surgery Department of Surgery The University of Hong KongQueen Mary Hospital Hong Kong ChinaDivision of Cardiothoracic Surgery Department of Surgery The University of Hong KongQueen Mary Hospital Hong Kong ChinaDepartment of Cardiology Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital Nanjing ChinaDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaNational Heart Centre Singapore SingaporeDivision of Cardiology Department of Medicine The University of Hong Kong Shenzhen Hospital Shenzhen ChinaBackground Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery.https://www.ahajournals.org/doi/10.1161/JAHA.121.024060heart failurehepatorenal dysfunctionmalnutritionrisk‐stratificationvalvular surgery |
| spellingShingle | Yi‐Kei Tse Chanchal Chandramouli Hang‐Long Li Si‐Yeung Yu Mei‐Zhen Wu Qing‐Wen Ren Yan Chen Pui‐Fai Wong Ko‐Yung Sit Daniel Tai‐Leung Chan Cally Ka‐Lai Ho Wing‐Kuk Au Xin‐Li Li Hung‐Fat Tse Carolyn S. P. Lam Kai‐Hang Yiu Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure hepatorenal dysfunction malnutrition risk‐stratification valvular surgery |
| title | Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure |
| title_full | Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure |
| title_fullStr | Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure |
| title_full_unstemmed | Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure |
| title_short | Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure |
| title_sort | concomitant hepatorenal dysfunction and malnutrition in valvular heart surgery long term prognostic implications for death and heart failure |
| topic | heart failure hepatorenal dysfunction malnutrition risk‐stratification valvular surgery |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024060 |
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