ArticleJournal of cardiothoracic surgery2026
Comparative prognostic performance of six nutritional risk scores in predicting early outcomes after open heart surgery: a prospective cohort study.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPreoperative nutritional status is a critical determinant of outcomes in cardiac surgery, yet its integration into conventional surgical risk assessment remains limited. This study aimed to compare the prognostic value of six nutritional scoring systems and evaluate whether combining them with European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) improves prediction of 30-day mortality and postoperative complications in patients undergoing open heart surgery.
methodsIn this prospective cohort study, 120 adult patients undergoing elective open heart surgery were assessed preoperatively using six nutritional indices: Controlling Nutritional Status (CONUT), Nutritional Risk Screening 2002 (NRS2002), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Index (NRI), Subjective Global Assessment (SGA), and Mini Nutritional Assessment (MNA). The primary endpoint was 30-day all-cause mortality. Secondary outcomes included major postoperative complications and length of stay. Logistic regression models, receiver operating characteristic (ROC) curve analyses, and model fit statistics were used to assess predictive performance.
resultsIn univariable analysis, all six nutritional scores were associated with 30-day mortality. In multivariable models including EuroSCORE II and each nutritional index, only the Mini Nutritional Assessment (MNA) remained an independent predictor (p = 0.020). The addition of MNA to EuroSCORE II significantly improved overall model fit (Likelihood Ratio Test, p = 0.020) and increased the Nagelkerke R² from 0.259 to 0.342. The area under the ROC curve (AUC) also increased from 0.842 to 0.864, indicating enhanced discriminative ability for 30-day mortality. Higher nutritional risk was also associated with prolonged intensive care unit (ICU)/hospital stay and increased rates of atrial fibrillation, pneumonia, and acute kidney injury.
conclusionMNA is an independent predictor of early postoperative mortality in cardiac surgery patients and provides incremental prognostic value when added to EuroSCORE II. Incorporating nutritional assessment into preoperative evaluation may enhance risk stratification and support targeted interventions to improve surgical outcomes.
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