The relationship between the severity of rheumatic mitral valve stenosis and prognostic nutritional index and controlling nutritional status scores

İntroduction and aim: Despite its decreasing frequency, the most common cause of mitral valve stenosis, which is one of the important causes of morbidity and mortality, is still rheumatic valvular disease. Rheumatic Mitral valve stenosis (RMVS) is a progressive disease with autoimmune, chronic inflammation and systemic endothelial dysfunction. Despite advances in diagnosis and treatment of RMVS, it progresses with high morbidity and mortality in developing countries. Therefore, it is important to anticipate patients at risk of developing stenosis in rheumatic heart disease. In this study, we aimed to investigate the relationship between prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores and severity of rheumatic mitral valve stenosis ıt has been found that it is associated with the prognosis of gastrointestinal cancers and some heart diseases and is used as objective parameters in the evaluation of both nutritional and immunological status of patients. Material and method: Our study is a single center, retrospective, analytical, case-control study. A total of 163 patients, including 121 patients with echocardiographically moderate-severe RMVS diagnosis and 42 healthy control groups, who were admitted to our outpatient clinic between January-2012 and December-2020, were included in the study. Hemogram, biochemistry, lipid profile, demographic characteristics, risk factors, electrocardiography and transthoracic echocardiography data were obtained from the hospital information management system at the first admission of the patients to the cardiology outpatient clinic. PNI score was calculated with the total lymphocyte count and albumin value in the peripheral blood of the patients; the CONUT score was calculated with the total lymphocyte count, total cholesterol amount and albumin value. Findings: 77% of the 163 patients were women and the mean age was 41.5 ± 10.2 years. The mean age of the patients in the RMVS group was 41.6 ± 10.5 and the mean age of the control group patients was 41.2 ± 9.1 years (p=0.856). No significant difference was found between the groups in terms of demographic and clinical findings. Valve areas of RMVS patients were measured as 1.3 (1.0-1.4) cm² and 1.3 (1.0-1.4) cm² by planimetric and pressure-half time methods, respectively. We measured the left atrium anteroposterior diameter, measured from the parasternal long axis, significantly higher in the RMVS group compared to the control group (p<0.001). Mitral valve insufficiency and tricuspid valve insufficiency were common in patients with RMVS. When the two groups were compared; PNI score was 47.2 (41.3-51.0) in RMVS group and 52.1 (50.3-55.7) in control group (p <0.001); the CONUT score was 2 (1-4) in the RM VS group and 1 (0-2) in the control group (p = 0.002). We found a statistically significant difference between the two groups. In the correlation analysis, there was a moderate and positive correlation between PNI score and planimetric mitral valve area (MVA) (rₛ = 0.251, p = 0.006) and a moderate and positive correlation (rₛ = 0.253, p = 0.005) between pressure-half time MVA; we found a weak and negative correlation between the CONUT score and planimetric MVA (rₛ = -0.234, p = 0.001) and a weak and negative correlation (rₛ = -0.245, p = 0.007) between pressure-half time MVA. In multivariate logistic regression analysis, low PNI score (OR: 0.803, 95% CI: 0.724-0.890, p <0.001) and high CONUT score (OR: 1.847, 95% CI: 1.261-2.703, p = 0.002) were independent in predicting the presence of RMVS we determined that there are risk factors. In the ROC analysis, when the PNI score was taken as 51.02 cut-off value, we found that it predicted moderate-severe RMVS with 75% sensitivity and 72% specificity. Conclusion: In patients with rheumatic mitral valve stenosis, we found a close relationship between the severity of the RMVS and the PNI and CONUT score, which are the evaluation indicators of nutritional status. Accordingly, we found that the low PNI score and the high CONUT score were independent risk factors in predicting the presence of RMVS. With this result, evaluation and follow-up of nutritional status in patients with rheumatic mitral valve disease may provide additional benefit in terms of whether stenosis develops in patients with rheumatic heart disease. Undoubtedly, more comprehensive studies are needed on this subject. Keywords: Rheumatic mitral valve stenosis, prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, predictor, prognosis