Hasan Can KÖNTE, Ömer ALYAN, Dursun ARAS
Anatolian Current Medical Journal - 2026;8(2):270-276
Aims: To evaluate the predictive value of the Naples prognostic score (NPS) and other nutritional indices for appropriate implantable cardioverter-defibrillator (ICD) therapy in primary prevention patients with heart failure with reduced ejection fraction (HFrEF). Methods: This retrospective cohort study included 288 adult patients with HFrEF who underwent primary prevention ICD implantation and followed for at least six months. Data were retrospectively collected from electronic medical records. The NPS, PNI, and CONUT scores were calculated from baseline laboratory values obtained at the time of ICD implantation. The primary endpoint was the predictive performance of NPS for appropriate ICD therapy. Results: Patients with appropriate therapy (n=194) were younger (p=0.002), had lower BMI (p<0.001), hemoglobin (p=0.020), and ischemic cardiomyopathy prevalence (p=0.025). Left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (p=0.002) were higher in recipients of appropriate ICD shocks. Nutritional scores showed better nutritional status in the appropriate therapy group: higher PNI (p<0.001), lower NPS (p=0.001) and lower CONUT (p=0.015). ROC analysis revealed similar and modest discriminatory capabilities for all nutrition assessment tools (AUCs from 0.587 to 0.630). Multivariable logistic regression identified low BMI (p=0.002), high LVEDD (p=0.007), and high albumin (p<0.001) as independent predictors of appropriate therapy. Conclusion: In primary prevention ICD recipients with HFrEF, appropriate therapy was linked to lower BMI, higher LVEDD, and elevated albumin, while nutritional indices showed univariate but not multivariable predictive value. The relatively high negative predictive values suggest a screening/supportive role for NPS (and other nutritional scores) in the context of ICD management in patients with HFrEF.
