(CCSP063) DETERMINING THE UTILITY OF THE CACHEXIA SCORE (CASCO) STAGING TOOL FOR CARDIAC CACHEXIA IN A HEART FAILURE POPULATION

Background: Cardiac cachexia is a multifactorial disease characterized by protein-calorie malnutrition, muscle wasting and a series of immunological, metabolic and neuro-hormonal processes. Mortality rates in patients with cachexia are three times higher than in those without, with a 1-year mortality rate of ~ 20-40%. The CASCO (CAchexia SCOre) tool was developed and validated as a cachexia-staging tool in patients with cancer and consists of five components: body weight loss and composition, inflammation/metabolic disturbances/immunosuppression, physical performance, anorexia and quality of life. Biomarker similarities exist between cancer cachexia and cardiac cachexia. The purpose of this study was to determine the utility of the CASCO and Mini-CASCO (shortened version) staging tool to predict outcomes in a heart failure population.

METHODS AND RESULTS: This was an exploratory prospective observational quantitative study. Recruitment took place over 5 months. CASCO and Mini-CASCO scoring was completed at baseline and 12 months (classifying patients as non-cachectic, mild, moderate or severe). Outcomes measured included infections, hospitalizations, and hospital length of stay (LOS).

44 patients with median age 64; 16 (36%) Female, 28 (64%) Male, were recruited into the study. Cachexia stage was not associated with a higher incidence of infections. The percentage of hospitalizations in the severe CASCO score was found to be higher (83%), than the other categories (Moderate 57%, Mild 0%, non-cachectic 37.5% (p = 0.05). Patients with severe cachexia were more likely to have a LOS that was >=20 days (60% severe, 50% moderate, 11% non cachectic, p=0.515). Among patients who underwent heart transplantation during the study period (n=9), severely cachectic patients were more likely to have a post-transplant LOS >=20 days compared to non-cachectic or mildly cachectic patients (60% vs. 0%). The components of the tool that were most predictive of clinical outcomes included body weight, biomarkers (hemoglobin, CRP, albumin and total lymphocytes) and the 3 questionnaires (Anorexia, Physical Performance and Quality of Life). There was a high level of agreement between the CASCO and the mini-CASCO scoring tool at both baseline (Kappa (95% CI): 0.89 (0.77, 1.0)) and 12 month collection (Kappa (95% CI): 0.81 (0.65, 0.97)).

Conclusion: The CASCO tool showed utility in determining who may be at risk for hospitalizations and longer LOS post heart transplant surgery. The specific components of the tool most predictive of outcomes were all found in the mini-CASCO tool which is valuable for a clinical setting where time is limited. Further research is needed to validate this tool in the cardiac setting.