The Association of Nutritional Risk Screening 2002 With 1-Year Re-hospitalization and the Length of Initial Hospital Stay in Patients With Heart Failure

Zhezhe Chen; Hangpan Jiang; Wujian He; Duanbin Li; Maoning Lin; Min Wang; Min Shang; Wenbin Zhang

doi:10.3389/fnut.2022.849034

The Association of Nutritional Risk Screening 2002 With 1-Year Re-hospitalization and the Length of Initial Hospital Stay in Patients With Heart Failure

Front Nutr. 2022 Apr 29:9:849034. doi: 10.3389/fnut.2022.849034. eCollection 2022.

Authors

Zhezhe Chen^{1

2}, Hangpan Jiang³, Wujian He^{1

2}, Duanbin Li^{1

2}, Maoning Lin^{1

2}, Min Wang^{1

2}, Min Shang^{1

2}, Wenbin Zhang^{1

2}

Affiliations

¹ Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
² Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.
³ Department of Cardiology, College of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, China.

Abstract

Backgrounds and aims: Nutritional Risk Screening 2002 (NRS-2002) has been widely recommended for identifying the nutritional risk. However, the association between NRS-2002 and the prognosis of heart failure has not been fully addressed. This study aimed to explore the association of NRS-2002 with 1-year re-hospitalization and the length of initial hospital stay in heart failure patients.

Methods: This retrospective study included 2,830 heart failure patients. The primary endpoint was 1-year re-hospitalization for heart failure. The secondary endpoint was the length of initial hospital stay. The Log-binomial regression analysis was performed to determine the association between NRS-2002 and re-hospitalization. The Cox regression model was fitted to estimate hazard of discharge. The cumulative incidence curves of discharge were plotted using Kaplan-Meier method and log-rank test was performed. Exploratory analysis was also conducted according to the classification of heart failure and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) fold-elevation.

Results: Among 2,830 heart failure patients, the mean age was 64.3 years and 66.4% were male. A total of 122 (4.3%) patients were considered at high nutritional risk. Log-binomial regression analysis demonstrated that higher NRS-2002 score was an independent risk factor of re-hospitalization ([1 vs. 0]: relative risks [RR] = 1.383, 95% CI = 1.152 to 1.660; [2 vs. 0]: RR = 1.425, 95% CI = 1.108 to 1.832; [3-7 vs. 0]: RR = 1.770, 95% CI = 1.310 to 2.393). Kaplan-Meier curve showed that the cumulative incidence of discharge was lower in high nutritional risk group (Log rank p < 0.001). Cox regression analysis also found that higher NRS-2002 score (2 or ≥3) was strongly associated with longer length of initial hospital stay ([2 vs. 0]: Hazard ratios [HR] = 0.854, 95% CI = 0.748 to 0.976; [3-7 vs. 0]: HR = 0.609, 95% CI = 0.503 to 0.737). Exploratory analysis showed that such association still remained irrespective of NT-proBNP fold-elevation, but only existed in patients with heart failure with preserved ejection fraction (HFpEF).

Conclusion: In patients with heart failure, high NRS-2002 score was strongly and independently associated with the incidence of 1-year re-hospitalization and the length of initial hospital stay.

Keywords: 1-year re-hospitalization; Nutritional Risk Screening 2002; heart failure; length of initial hospital stay; nutritional risk.