Aim: The aim of the present study was to assess the influence of nutritional status, as expressed by Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) scores, on the inflammatory response following acute myocardial infarction (AMI) and the impact of an altered nutritional status and increased systemic inflammation on immediate evolution following AMI.
Methods: This was an observational prospective study in which we used the CONUT score and GNRI on 86 consecutive patients with AMI receiving primary revascularisation, divided into a well-nourished group (CONUT score 0-2, n = 68) and moderate-to-severe nutritional deficit group (CONUT score ≥ 3, n = 18). Inflammatory status was assessed on the basis of highly sensitive C-reactive protein (hs-CRP) at baseline and on day 5.
Results: Malnourished patients presented significantly higher levels of serum hs-CRP at baseline (33.6 ± 35.02 mg/dL vs 10.26 ± 25.93 mg/dL, P < 0.0001) and day 5 (52.8 ± 46.25 mg/dL vs 17.04 ± 24.78 mg/dL, P < 0.0001). GNRI values showed a weak but significant correlation with serum hs-CRP at baseline (r = -0.26, P = 0.01) and day 5 (r = -0.44, P < 0.0001). Patients with altered nutritional status presented more frequent deterioration of their haemodynamical status, requiring inotropic support (P = 0.002) and longer hospitalisation in the acute cardiac care unit (4.27 ± 2.60 vs 2.85 ± 0.73 days, P = 0.005). Patients requiring intravenous inotropics had a higher CONUT score (2.31 ± 1.7 vs 1.17 ± 1.27, P = 0.01), lower GNRI (102.0 ± 5.31 vs 98.56 ± 5.2, P = 0.02) and higher hs-CRP levels at baseline and day 5 (31.40 ± 46.57 vs 18.52 ± 32.98, P = 0.04 and 46.04 ± 51.50 vs 19.60 ± 46.05, P = 0.006).
Conclusions: Malnourished patients with AMI had more expressed inflammation, increased blood vulnerability and worse outcomes.
Keywords: acute coronary care; hospital stay; inflammation; malnutrition; myocardial infarction; nutritional status.
© 2019 Dietitians Association of Australia.