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Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices

Publication ,  Journal Article
Contreras, FJ; Pinsker, BL; Katz, JN; Russell, SD; Schroder, J; Bryner, B; Gunn, AH; Amin, K; Milano, C
Published in: JTCVS Open
January 1, 2024

Objective: There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the HeartMate 3 (HM3) left ventricular assist device (LVAD). Methods: Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-proportional hazards model were used to identify predictors of outcome. Results: Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (hazard ratio [HR], 3.40; 95% confidence interval [CI], 1.66-6.97, P < .01), diabetes mellitus (HR, 0.46; 95% CI, 0.27-0.80, P < .01), body mass index ≥40 kg/m2 (HR, 2.63 per 1 kg/m2 increase; 95% CI, 1.22-5.70, P < .05), preoperative creatinine level (HR, 1.86 per 1 mg/dL increase; 95% CI, 1.31-2.65, P < .01), and preoperative prognostic nutritional index (PNI) score (HR, 0.88 per 1-point increase; 95% CI, 0.81-0.96, P < .01). Independent predictors of driveline infection included age at the time of implantation (HR, 0.97; 95% CI, 0.96-0.99, P < .01) and diabetes mellitus (HR, 1.79; 95% CI, 1.17-2.73, P < .01). Conclusions: Preoperative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine use of the PNI score during preoperative evaluation and, when possible, supplementation to PNI >33, may be of value in this population.

Duke Scholars

Published In

JTCVS Open

DOI

EISSN

2666-2736

Publication Date

January 1, 2024
 

Citation

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Contreras, F. J., Pinsker, B. L., Katz, J. N., Russell, S. D., Schroder, J., Bryner, B., … Milano, C. (2024). Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices. JTCVS Open. https://doi.org/10.1016/j.xjon.2024.03.017
Contreras, F. J., B. L. Pinsker, J. N. Katz, S. D. Russell, J. Schroder, B. Bryner, A. H. Gunn, K. Amin, and C. Milano. “Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices.” JTCVS Open, January 1, 2024. https://doi.org/10.1016/j.xjon.2024.03.017.
Contreras FJ, Pinsker BL, Katz JN, Russell SD, Schroder J, Bryner B, et al. Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices. JTCVS Open. 2024 Jan 1;
Contreras FJ, Pinsker BL, Katz JN, Russell SD, Schroder J, Bryner B, Gunn AH, Amin K, Milano C. Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices. JTCVS Open. 2024 Jan 1;

Published In

JTCVS Open

DOI

EISSN

2666-2736

Publication Date

January 1, 2024