Assessing Nutritional Risk Can Predict PAH Prognosis at First Hospitalization

Using the Geriatric Nutritional Risk Index (GNRI) when patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) are hospitalized can help predict their prognosis, according to a study published in Circulation Reports.

PAH and CTEPH are considered precapillary pulmonary hypertension (PH). Among patients with precapillary PH, “undernutrition may trigger or aggravate disease progression. However, it is unclear whether undernutrition at the point of diagnosis is significantly associated with prognoses in patients with precapillary PH,” the authors explained.

The study included 104 patients with either PAH or CTEPH who were treated at the Kagoshima University Hospital in Japan. The majority of patients (84.6%) were female and 68.3% were World Health Organization functional class III or IV; the mean age was 60 years.

A score of < 92 was considered a low GNRI and ≤ 92 was considered a high GNRI. Patients with a low GNRI were more likely to be younger (54 years) compared with the patients with a high GNRI (61 years). Patients in the low-GNRI group also had significantly lower body mass index, serum albumin levels, and hemoglobin.

The median follow-up period was 24 months, during which 16 (15.4%) patients died. The composite outcome of either rehospitalization or all-cause death occurred in nearly half (45.5%) of patients in the low-GNRI group compared with 20.7% of patients in the high-GNRI group. After adjusting for potentially confounding covariates, the researchers still found a higher likelihood of all-cause death or rehospitalization for patients with low GNRI.

“Taken together, these results suggest that undernutrition at the time of diagnosis is a potent prognosticator in patients with PH,” the authors wrote.

They did list a number of limitations, including the relatively small sample size and the retrospective nature of the study. The study only evaluated GNRI scores once, so they could not assess changes in GNRI. In addition, they admitted there may have been unmeasured confounding factors that were not excluded.

The authors suggested that further studies evaluate the effectiveness of nutritional interventions in patients with PAH and CTEPH since undernutrition and weight loss are frequent among them.

“The present study suggests that the GNRI score at first hospitalization may be a simple predictor of prognosis in patients with PAH and CTEPH,” they concluded. “Adjunct nutritional therapies may improve outcomes in such patients.”

Reference

Kubota K, Miyanaga S, Iwatani N, et al. Geriatric nutritional risk index is associated with prognosis in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Circ Rep. 2020;2(7):372-377. doi:10.1253/circrep.CR-20-0046