| Predicting mortality risks in patients with heart failure using body mass index and weight loss at admission |
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Yuria Ishida1,2, Keisuke Maeda2,3,4, Kenta Murotani5, Akio Shimizu2,6, Junko Ueshima2,7, Ayano Nagano2,8, Tatsuro Inoue9, Naoharu Mori2,3 |
1Department of Nutrition, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
2Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
3Nutritional Therapy Support Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
4Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu Aichi, 474-8511, Japan
5Biostatistics Center, Kurume University, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
6Department of Health Science, Faculty of Health and Human Development, The University of Nagano, 8-49-7 Miwa, Nagano, Nagano, 380-8525, Japan
7Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-0022, Japan
8Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
9Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho 950-3198, Japan |
Correspondence:
Keisuke Maeda,
Email: kskmaeda1701@gmail.com
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Received: 27 December 2023 • Revised: 26 February 2024 • Accepted: 8 March 2024 |
| Abstract |
Background
The association of the combination of body mass index (BMI) and weight change at admission with prognoses in patients with heart failure (HF) is unclear. Therefore, we investigated whether body mass index (BMI) and weight changes at admission affect mortality in patients with HF.
Methods
This retrospective cohort study lasted 99 months, starting in April 2014, and included 4,862 patients with HF from a Japanese real-world database. Cubic and thin-plate smoothing spline analyses were performed to investigate the association of BMI and weight changes with mortality. The percentage weight change was calculated every 6 months. The study outcome was the presence or absence of death.
Results
The patients’ mean age was 81.5±9.6 years, and 1,239 (25.5%) patients died. Cubic spline analysis revealed a negative correlation of BMI with mortality hazard ratio (HR) (BMI=18.5 kg/m2 and 25 kg/m2; HR=1.3 [1.2–1.4] and 0.8 [0.7–0.9], respectively). Cubic spline analysis of weight change showed that weight loss tended to increase the mortality HR (weight change rate=-6%, HR=1.1 [1.0–1.2]). Thin-plate smoothing spline analysis showed that the odds ratio (OR) negatively correlated with BMI (1-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.5, 1.0, and 0.7, respectively; 2-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.4, 0.9, and 0.7, respectively).
Conclusion
A low BMI in patients with HF was associated with a higher risk of mortality. Weight loss in patients, regardless of BMI, was associated with a higher OR for mortality. |
| Key Words:
Cachexia, Heart failure, Asian, Prognosis, Obesity paradox |
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