This retrospective study found associations between inferior nutritional index scores, malnutrition, and prognoses in patients with pulmonary arterial hypertension (PAH).
PAH often causes right-heart failure. Outside of PAH, heart failure is known to affect one’s appetite, nutritional absorption, and lead to malnutrition. For this reason, nutritional assessments are routinely recommended for patients who experience heart failure; however, despite PAH’s association with heart failure, there is a gap in knowledge regarding the influence of malnutrition on PAH outcomes.
The referenced nutritional assessments mainly analyze scores from the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT). GNRI is calculated by serum albumin levels and lower scores here indicate worse outcomes. PNI is a tool for measuring lymphocytes and worse outcomes are also indicated by lower scoring. CONUT assessments also total lymphocytes while additionally including cholesterol and factors in lipid metabolism; however, higher CONUT scores are associated with worse outcomes.
Although these assessments have confirmed the connection between heart failure outcomes and worse scores, they have not produced conclusive evidence that makes direct associations between poor scoring and PAH prognosis. Taking this into account, researchers set out to evaluate correlations between nutritional status and all-cause death or pulmonary transplants occurring in patients after a PAH diagnosis.
Data were gathered from patients cared for at Okayama University Hospital in Japan between January 1997 and October 2018. In total, 80 with PAH were eligible for analysis. Researchers evaluated their blood results and physical examinations (which included measuring a 6-minute walking distance exercise) to generate GNRI, PNI, and CONUT scores. Patients were divided into 2 prognostic groups: survivors and nonsurvivors.
Patients had a mean age of 59 years and were followed up with for an average of 5.5 years. Twenty-three of the patients were men, and 57 were women. Of the 80 patients included, 24 died over the course of this study and 3 required lung transplantations.
The authors found significantly different prognostic outcomes related to the sex of nonsurvivors and survivors (44.4% women vs 20.8% men; P = .002), as well as right arterial pressure (7.8 mm Hg vs 5.5 mm Hg; P = .02) and 6-minute walking distance (272 m vs 386 m; P = .002).
Nonsurvivors and survivors also exhibited significant differences in serum albumin (3.5 g/dL vs 4.0 g/dL; P = .002), brain natriuretic peptides (257.3 pg/mL vs 78.6 pg/mL; P = .008), serum creatinine (0.8 mg/dL vs 0.7 mg/dL; P = .044), and total cholesterol (154.3 mg/dL vs 174.9 mg/dL; P = .041).
Worse prognoses were apparent for patients who scored worse in the GNRI, PNI, and CONUT. These results show a significant association between nutritional status, malnutrition, and prognosis for patients with PAH. As such, the authors believe these assessments should be regarded as useful tools for predicting and evaluating patients’ risk in the future.
In their closing remarks, the authors took time to note the remaining complexities of studies concerning PAH and nutrition. Of those intricacies, some of particular interest include the causal link between PAH-targeting medication and nutritional status. In a myriad of ways, many of these medications contribute to poorer nutritional standing in patients with PAH. In the same breath, the researchers reiterate PAH’s influence on the heart and malnourishment. Their conclusion touches on 2 very important concerns that impact outcomes for patients with PAH. Because of this, they encourage further studies to continue exploring the associations between nutritional factors and PAH.
Nakashima M, Akagi S, Ejiri K, Nakamura K, Ito H. Impact of malnutrition on prognosis in patients with pulmonary arterial hypertension. Pulm Circ. 2023;13(3):e12286. doi:10.1002/pul2.12286