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Prognostic implications of Global Leadership Initiative on Malnutrition–defined malnutrition in older patients who underwent cardiac surgery in China

  • Zhang Liu
    Affiliations
    Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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  • Wangfu Zang
    Affiliations
    Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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  • Peng Zhang
    Correspondence
    Reprint requests: Peng Zhang, MD, Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, 200072, Shanghai, China.
    Affiliations
    Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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  • Zile Shen
    Correspondence
    Reprint requests: Zile Shen, MD, PhD, Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, 200072, Shanghai, China.
    Affiliations
    Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Published:December 06, 2022DOI:https://doi.org/10.1016/j.surg.2022.11.008

      Abstract

      Background

      The proportion of older patients who are candidates for cardiac surgery is increasing. Growing evidence has shown that malnutrition is associated with a poor prognosis after cardiac surgery. The present study aimed to investigate the prognostic implications of malnutrition defined by the Global Leadership Initiative on Malnutrition in older patients who underwent cardiac surgery.

      Methods

      From November 2015 to January 2021, 401 older patients who underwent cardiac surgery were retrospectively enrolled and evaluated using the Global Leadership Initiative on Malnutrition criteria. The perioperative characteristics and clinical outcomes were collected. The independent risk factors for postoperative complications and overall survival were analyzed.

      Results

      The prevalence of Global Leadership Initiative on Malnutrition–defined malnutrition was 22.7% in this study. Patients with Global Leadership Initiative on Malnutrition–defined malnutrition had higher risks of postoperative complications (65.9% vs 49.7%, P = .006) and poor overall survival (68.1% vs 83.9%, P = .0019). Global Leadership Initiative on Malnutrition–defined malnutrition was also related to a longer postoperative hospital stay and prolonged intensive care stay. Five factors were identified as independent risk factors for overall survival: Global Leadership Initiative on Malnutrition–defined malnutrition (P = .009), chronic heart failure (P = .007), atrial fibrillation (P = .029), operative time (P < .001) and hemoglobin (P = .044).

      Conclusion

      We demonstrated the prognostic implications of Global Leadership Initiative on Malnutrition–defined malnutrition in older patients who underwent cardiac surgery for the first time. This study highlights the necessity of using the Global Leadership Initiative on Malnutrition assessment in the comprehensive preoperative risk assessment of cardiac surgery.
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      References

        • Shahian D.M.
        • O'Brien S.M.
        • Filardo G.
        • et al.
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery.
        Ann Thorac Surg. 2009; 88: S2-S22
        • Chivasso P.
        • Bruno V.D.
        • Farid S.
        • et al.
        Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: the mitral surgery in octogenarians study.
        J Thorac Cardiovasc Surg. 2018; 155: 1474-1482.e2
        • Atladottir H.O.
        • Modrau I.S.
        • Jakobsen C.J.
        • Torp-Pedersen C.T.
        • Gissel M.S.
        • Nielsen D.V.
        Impact of perioperative course during cardiac surgery on outcomes in patients 80 years and older.
        J Thorac Cardiovasc Surg. 2021; 162: 1568-1577
        • Likosky D.S.
        • Dacey L.J.
        • Baribeau Y.R.
        • et al.
        Long-term survival of the very elderly undergoing coronary artery bypass grafting.
        Ann Thorac Surg. 2008; 85: 1233-1237
        • Speziale G.
        • Nasso G.
        • Barattoni M.C.
        • et al.
        Short-term and long-term results of cardiac surgery in elderly and very elderly patients.
        J Thorac Cardiovasc Surg. 2011; 141 (731.e1): 725-731
        • Alexander K.P.
        • Anstrom K.J.
        • Muhlbaier L.H.
        • et al.
        Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network.
        J Am Coll Cardiol. 2000; 35: 731-738
        • Collart F.
        • Feier H.
        • Kerbaul F.
        • et al.
        Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results.
        Eur J Cardiothorac Surg. 2005; 27: 276-280
        • Dupuis J.Y.
        Predicting outcomes in cardiac surgery: risk stratification matters?.
        Curr Opin Cardiol. 2008; 23: 560-567
        • O'Neill D.E.
        • Knudtson M.L.
        • Kieser T.M.
        • Graham M.M.
        Considerations in cardiac revascularization for the elderly patient: age isn't everything.
        Can J Cardiol. 2016; 32: 1132-1139
        • O'Keeffe M.
        • Kelly M.
        • O'Herlihy E.
        • et al.
        Potentially modifiable determinants of malnutrition in older adults: a systematic review.
        Clin Nutr. 2019; 38: 2477-2498
        • Norman K.
        • Hass U.
        • Pirlich M.
        Malnutrition in older adults-recent advances and remaining challenges.
        Nutrients. 2021; 13: 2764
        • Lomivorotov V.V.
        • Efremov S.M.
        • Boboshko V.A.
        • et al.
        Evaluation of nutritional screening tools for patients scheduled for cardiac surgery.
        Nutrition. 2013; 29: 436-442
        • Gucu A.
        • Ozluk O.A.
        • Sunbul S.A.
        • Engin M.
        • Seker I.B.
        • Sunbul A.
        Prognostic nutritional index as a marker of mortality: an observational cohort study of patients undergoing cardiac surgery.
        Rev Cardiovasc Med. 2021; 22: 499-503
        • Chermesh I.
        • Hajos J.
        • Mashiach T.
        • et al.
        Malnutrition in cardiac surgery: food for thought.
        Eur J Prev Cardiol. 2014; 21: 475-483
        • Kawakami K.
        • Kadota J.
        • Iida K.
        • Shirai R.
        • Abe K.
        • Kohno S.
        Reduced immune function and malnutrition in the elderly.
        Tohoku J Exp Med. 1999; 187: 157-171
        • Lengele L.
        • Bruyere O.
        • Beaudart C.
        • Reginster J.Y.
        • Locquet M.
        Impact of malnutrition status on muscle parameter changes over a 5-year follow-up of community-dwelling older adults from the SarcoPhAge cohort.
        Nutrients. 2021; 13: 407
        • Cederholm T.
        • Jensen G.L.
        • Correia M.
        • et al.
        GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community.
        Clin Nutr. 2019; 38: 1-9
        • Seoudy H.
        • Al-Kassou B.
        • Shamekhi J.
        • et al.
        Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index.
        J Cachexia Sarcopenia Muscle. 2021; 12: 577-585
        • Liu Z.
        • Shen Z.
        • Zang W.
        • et al.
        Development and validation of Global Leadership Initiative on Malnutrition for prognostic prediction in patients who underwent cardiac surgery.
        Nutrients. 2022; 14: 2409
        • Liu Z.
        • Shen Z.
        • Zhang P.
        • et al.
        Prognostic effect of thoracic sarcopaenia on short- and long-term clinical outcomes in patients who underwent cardiac valve surgery.
        Heart Lung Circ. 2022; 31: 1408-1418
        • Derstine B.A.
        • Holcombe S.A.
        • Ross B.E.
        • Wang N.C.
        • Su G.L.
        • Wang S.C.
        Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population.
        Sci Rep. 2018; 8: 11369
        • Weber C.
        • Noels H.
        Atherosclerosis: current pathogenesis and therapeutic options.
        Nat Med. 2011; 17: 1410-1422
        • Schoen F.J.
        Mechanisms of function and disease of natural and replacement heart valves.
        Annu Rev Pathol. 2012; 7: 161-183
        • Poullis M.
        • Pullan M.
        • Chalmers J.
        • Mediratta N.
        The validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy.
        Interact Cardiovasc Thorac Surg. 2015; 20: 172-177
        • Fang E.F.
        • Xie C.
        • Schenkel J.A.
        • et al.
        A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term care, policy and social networks.
        Ageing Res Rev. 2020; 64: 101174
        • Friedrich I.
        • Simm A.
        • Kotting J.
        • Tholen F.
        • Fischer B.
        • Silber R.E.
        Cardiac surgery in the elderly patient.
        Dtsch Arztebl Int. 2009; 106: 416-422
        • Portuondo J.I.
        • Probstfeld L.
        • Massarweh N.N.
        • et al.
        Malnutrition in elective surgery: how traditional markers might be failing surgeons and patients.
        Surgery. 2020; 168: 1144-1151
        • Besora-Moreno M.
        • Llaurado E.
        • Tarro L.
        • Sola R.
        Social and economic factors and malnutrition or the risk of malnutrition in the elderly: a systematic review and meta-analysis of observational studies.
        Nutrients. 2020; 12: 737
        • Schiffman S.S.
        • Graham B.G.
        Taste and smell perception affect appetite and immunity in the elderly.
        Eur J Clin Nutr. 2000; 54: S54-S63
        • Morais J.A.
        • Jacob K.W.
        • Chevalier S.
        Effects of aging and insulin resistant states on protein anabolic responses in older adults.
        Exp Gerontol. 2018; 108: 262-268
        • Barclay R.D.
        • Burd N.A.
        • Tyler C.
        • Tillin N.A.
        • Mackenzie R.W.
        The Role of the IGF-1 signaling cascade in muscle protein synthesis and anabolic resistance in aging skeletal muscle.
        Front Nutr. 2019; 6: 146
        • Correia M.I.
        • Waitzberg D.L.
        The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.
        Clin Nutr. 2003; 22: 235-239
        • Wang Y.
        • Jiang H.
        • Zhu M.W.
        • et al.
        Establishing a new body mass index cutoff value for malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) tool in Chinese older adults.
        JPEN J Parenter Enteral Nutr. 2022; 46: 1071-1079
        • Lopez-Delgado J.C.
        • Munoz-Del Rio G.
        • Flordelis-Lasierra J.L.
        • Putzu A.
        Nutrition in adult cardiac surgery: preoperative evaluation, management in the postoperative period, and clinical implications for outcomes.
        J Cardiothorac Vasc Anesth. 2019; 33: 3143-3162
        • Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)
        The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis.
        Eur Heart J. 2012; 33: 1750-1757
        • Malaisrie S.C.
        • McCarthy P.M.
        • Kruse J.
        • et al.
        Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.
        J Thorac Cardiovasc Surg. 2018; 155: 2358-2367.e1
        • Zakkar M.
        • Ascione R.
        • James A.F.
        • Angelini G.D.
        • Suleiman M.S.
        Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery.
        Pharmacol Ther. 2015; 154: 13-20
        • Hall R.
        Identification of inflammatory mediators and their modulation by strategies for the management of the systemic inflammatory response during cardiac surgery.
        J Cardiothorac Vasc Anesth. 2013; 27: 983-1033
        • Zhou L.
        • Liu X.
        • Yan M.
        • et al.
        Postoperative nadir hemoglobin and adverse outcomes in patients undergoing on-pump cardiac operation.
        Ann Thorac Surg. 2021; 112: 708-716
        • Barazzoni R.
        • Jensen G.L.
        • Correia M.
        • et al.
        Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition.
        Clin Nutr. 2022; 41: 1425-1433
        • Heyland D.K.
        • Stapleton R.D.
        • Mourtzakis M.
        • et al.
        Combining nutrition and exercise to optimize survival and recovery from critical illness: conceptual and methodological issues.
        Clin Nutr. 2016; 35: 1196-1206