NIH Research Festival
BACKGROUND: Frailty is common in heart failure (HF) and associated with mortality but not routinely captured clinically. Frailty is linked with inflammation and malnutrition, which can be assessed by a novel plasma multimarker score: the Metabolic Vulnerability Index (MVX). We sought to evaluate the associations between frailty and MVX, and their prognostic impact.
METHODS: In a HF community cohort (2003-2012), we measured frailty as a proportion of deficits present out of 32 physical limitations and comorbidities, MVX by nuclear magnetic resonance spectroscopy and collected extensive longitudinal clinical data. Patients were categorized by frailty score (‚â§0.15; >0.15 and ‚â§0.27; >0.27) and MVX score (‚â§50; >50 and ‚â§60; >60 and ‚â§70; >70). Cox models estimated associations of frailty and MVX with mortality, adjusted for Meta-Analysis Global Group in Chronic HF (MAGGIC) score and NT-proBNP. Uno‚Äôs C-statistic measured incremental value of MVX beyond frailty and clinical factors. Weibull‚Äôs accelerated failure time regression assessed whether MVX mediated the association between frailty and mortality.
RESULTS: We studied 985 patients (median age 77, 48% women). Frailty and MVX were weakly correlated (Spearman œÅ=0.21). The highest frailty group experienced an increased rate of death, independent of MVX, MAGGIC score and NT-proBNP (HR=3.3, 95% CI: 2.6, 4.2). Frailty improved Uno‚Äôs c-statistic beyond MAGGIC score and NT-proBNP (0.71 to 0.73). MVX mediated <10% of the association between frailty and mortality.
CONCLUSIONS: In this HF cohort, frailty and MVX are weakly correlated. Both independently contribute stratifying the risk of death suggesting they capture distinct domains of vulnerability in HF.
Scientific Focus Area: Epidemiology
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