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Background Nutritional status is associated with poor outcomes in patients with heart failure. Serum cholinesterase (CHE) concentration, a marker of malnutrition, was reported to be a prognostic factor in patients with chronic heart failure. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are established objective nutritional indices. Objective The aim of this study was to clarify the prognostic significance of CHE concentration and to compare it with other well-established objective nutritional indices in patients with acute decompensated heart failure (ADHF). Methods We prospectively enrolled 371 consecutive patients admitted for ADHF with survival discharge. Laboratory data including CHE and the objective nutritional indices were obtained at discharge. The primary endpoint of this study was all-cause mortality. Results During a mean ± SD follow-up period of 2.5 ± 1.4 y, 112 patients died. CHE concentration was significantly associated with all-cause mortality independently of GNRI, CONUT score, or PNI, after adjustment for major confounders including other nutritional indices, such as age, sex, systolic blood pressure, BMI, left ventricular ejection fraction, history of hypertension, diabetes mellitus, dyslipidemia, prior heart failure hospitalization, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, β-blocker use, statin use, hemoglobin, sodium, blood urea nitrogen, albumin, C-reactive protein, and brain natriuretic peptide concentrations via multivariable Cox analysis. Kaplan–Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with CHE stratum [lowest tertile: 53%, adjusted HR: 6.92; 95% CI: 3.87, 12.36, compared with middle tertile: 28%, adjusted HR: 2.72; 95% CI: 1.45, 5.11, compared with highest tertile: 11%, adjusted HR: 1.0 (reference), P  < 0.0001]. CHE showed the best area under the curve value (0.745) for the prediction of all-cause mortality compared with the other objective nutritional indices. Net reclassification improvement afforded by adding CHE to the fully adjusted multivariable model was statistically significant for all-cause mortality (0.330; 95% CI: 0.112, 0.549, P  = 0.0030). Conclusion CHE is a simple, strong prognostic marker for the prediction of all-cause mortality in patients with ADHF. [ABSTRACT FROM AUTHOR]

Background: The Get With the Guidelines-Heart Failure (GWTG-HF) risk score was recently developed to predict in-hospital mortality in patients admitted with acute decompensated heart failure (ADHF). However, little is known about the ability of the risk score to predict poor prognosis after hospital discharge in ADHF patients, and it remains unclear which measure of GWTG-HF risk score (admission, discharge, or the change from admission to discharge) is the most important predictor of poor prognosis after hospital discharge. Methods: We prospectively studied 372 consecutive patients who were admitted for ADHF and survived to discharge. Venous blood sampling and echocardiography were performed on admission and just before discharge. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, blood urea nitrogen and sodium levels, and the presence of chronic obstructive pulmonary disease. The study endpoint was all-cause death. Results: During the follow-up period of 2.5±1.4 years, 108 patients had all-cause death. Multivariate Cox regression analysis that included clinical, hemodynamic, biochemical, and echocardiographic parameters and the GWTG-HF risk score (admission, discharge, or the change from admission to discharge) showed that only the GWTG-HF risk score measured at discharge was an independent predictor of all-cause mortality (p=0.0233) among the three measures of the risk score. Although the GWTG-HF risk score on admission was one of the univariate predictors of all-cause death, receiver operating characteristic curve analysis confirmed the higher accuracy of GWTG-HF risk score at discharge (AUC=0.726, 95% CI: 0.678-0.771) over on admission (AUC=0.666, 95% CI: 0.615-0.714) in predicting the endpoint (p=0.0461). The change of GWTG-HF risk score from admission to discharge was not a significant predictor of all-cause death even in univariate analysis. Kaplan-Meier analysis showed that patients with GWTG-HF risk score >40 (median value) at discharge had a significantly higher risk of all-cause death (p<0.0001, HR 2.99 [95% CI: 2.04-4.40]). Conclusions: The GWTG-HF risk score predicts poor prognosis after hospital discharge, and the score measured at discharge best predicts all-cause mortality in ADHF patients. [ABSTRACT FROM AUTHOR]

Introduction: Plasma volume (PV) expansion plays an essential role in heart failure (HF). Recently, it has been reported that PV can be estimated by a simple formula based on hematocrit and body weight, and PV status (PVS) provides prognostic information in patients with chronic HF. In addition, malnutrition has been associated with increased mortality in HF patients, and the controlling nutritional status (CONUT) score is a previously established objective nutritional index. Hypothesis: We assessed the hypothesis that PVS and CONUT score have incremental prognostic value even in patients who are admitted for acute decompensated heart failure (ADHF). Methods: We prospectively studied 362 consecutive patients who were admitted for ADHF and survived to discharge. Body weight measurement and venous blood sampling were performed just before discharge. PVS was defined as follows: actual PV = (1 - hematocrit) х [a + (b х body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c х body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] х 100 (%). The CONUT score was calculated by serum albumin and total cholesterol levels, and total lymphocyte counts as previously reported. The study endpoint was all-cause death. Results: During a follow-up period of 2.5±1.4 years, 108 patients had all-cause death. Multivariate Cox analysis showed that both PVS and CONUT score were independent predictors of all-cause death (p=0.0005 and p=0.0013, respectively). Kaplan-Meier analysis showed that there was a significant difference in the risk of the endpoint when patients were stratified into 3 groups based on the median values of PVS (12.1%) and CONUT score (3 points) (Figure). Conclusions: PVS and CONUT score had incremental prognostic value in even in ADHF patients. [ABSTRACT FROM AUTHOR]