Prognostic implication of inflammation and anorexia in older patients hospitalized for heart failure

Background Although anorexia is a major component of cachexia, it may occur independently as "anorexia of aging" in older patients with heart failure (HF). Its prognostic impact with and without inflammation is unclear. Purpose This study aimed to investigate whether anorexia, with or without elevated C-reactive protein (CRP) as a marker of systemic inflammation, predicts mortality in older patients hospitalized for HF. Methods We analyzed data from the FRAGILE-HF prospective cohort of older patients (≥65 years) hospitalized for HF. Patients were categorized into four groups based on CRP (> or ≤0.5 mg/dL) as an inflammatory measure of cachexia and anorexia assessed via questionnaire, and were followed for 2 years. Results Of 1,226 patients (80.1 ± 7.7 years, 42.1% women, left ventricular ejection fraction 46 ± 17%), 544 patients (44.4%) reported anorexia at discharge. Median CRP with 25th and 75th percentiles was 2.7 mg/L [1.1-7.8]. Overall, 257 patients (21%) died within 2 years of discharge. In Cox models adjusted for the Meta-Analysis Global Group in Chronic Heart Failure score and B-type natriuretic peptide, adjusted hazard ratios for all-cause death were 1.10 [95% CI, 0.79-1.54; p=0.58], 1.16 [95% CI, 0.78-1.72; p=0.47], and 1.61 [95% CI, 1.11-2.34; p=0.011], in the low-CRP/anorexia, high-CRP/no anorexia, and high-CRP/anorexia groups, respectively, compared with low-CRP/no anorexia (Figure 1). No statistically significant interaction was found between elevated CRP levels and anorexia. Sensitivity analysis using alternative cachexia measures or other CRP thresholds yielded similar results (Figure 2). Conclusions The coexistence of inflammation and anorexia independently predicted all-cause mortality in older patients with HF, although no statistical interaction was observed between their prognostic effects.