Prognostic factors in heart failure patients with cardiac cachexia

Objective To clarify whether cardiac cachexia(CC) alters the prognostic impact of other general risk factors in patients with heart failure(HF). Methods This was an observational study. CC was defined as the combination of a body mass index of < 20 kg/m~2 and at least one of the following biochemical abnormalities: C-reactive protein > 5 mg/L; hemoglobin < 12 g/dL; and/or albumin < 3.2 g/d L. We divided 1608 hospitalized HF patients into a CC group(n=176, 10.9%) and a non-CC group(n=1432, 89.1%). The primary endpoints were cardiac event and all-cause death. Results The presence of CC showed significant interactions with other risk factors including cancer, estimated glomerular filtration rate(eGFR), and sodium in predicting these endpoints. Multiple Cox proportional analysis revealed that use of a blockers [hazard ratio(HR)=1.900, 95% confidence interval(CI):1.045–3.455, P=0.035) and eGFR(HR=0.989, 95% CI: 0.980–0.998, P=0.018) were independent predictors of cardiac event in the CC group, while age(HR=1.020, 95% CI: 1.002–1.039, P=0.029) and hemoglobin(HR=0.844, 95% CI: 0.734–0.970, P=0.017) were independent predictors of all-cause death. The survival classification and regression tree analysis showed the optimal cut-off points for cardiac event(eGFR: 59.9 m L/min per 1.73 m~2) and all-cause death(age, 83 years old; hemoglobin, 10.1 g/dL) in the CC group. Conclusions In predicting prognosis, CC showed interactions with several risk factors. Renal function, age, and hemoglobin were pivotal markers in HF patients with CC.