Nutritional Status is Associated with Inflammation and Predicts a Poor Outcome in Patients with Chronic Heart Failure.

Aim: Malnutrition has been identified to be an independent predictor of morbidity and mortality in patients with chronic heart failure (CHF). However, the pathophysiological mechanisms underlying this pathway remain unclear. Methods: Nutritional screening was performed using the controlling nutritional status (CONUT) score, which was calculated using the serum albumin and total cholesterol levels and lymphocyte number, in 114 CHF patients with a mean left ventricular ejection fraction of 26.6% +/- 6.4%. The carotid intima-media thickness (CIMT) is correlated with carotid atherosclerosis and is a significant predictor of future cardiovascular events. Peripheral blood mononuclear cells (PBMCs) were isolated, and the production of monocyte tumor necrosis factor (TNF)-alpha was measured and expressed as mean +/- SD (pg/mL/10(6) PBMCs). Results: A multivariate linear regression analysis showed that the production of monocyte TNF-alpha (beta coefficient = 0.434, p< 0.001) and mean CIMT (beta coefficient = 0.204, p= 0.006) were independent determinants of the CONUT score. During a median follow-up of 67.5 months, 45 patients experienced cardiac events, including 16 cardiac deaths and 29 readmissions for worsening CHF. A multivariate Cox hazard analysis demonstrated that a monocyte TNF-alpha level of >= 4.1 pg/mL/106 PBMCs (hazard ratio (HR), 14.10; 95% confidence interval (CI), 2.55-77.92; p = 0.002) and CONUT score of = 3 (HR, 11.97; 95% CI, 2.21-64.67; p = 0.004) were independently associated with the incidence of cardiac events. Conclusions: These data indicate that a poor nutritional status as assessed using the CONUT score and atherosclerosis as indicated by CIMT is significantly associated with inflammation and predicts poor outcomes in patients with CHF.