心力衰竭患者非故意体重减轻与无心脏事件生存期的关联。
The link of unintentional weight loss to cardiac event-free survival in patients with heart failure.
作者信息
Song Eun Kyeung, Lee Yongjik, Moser Debra K, Dekker Rebecca L, Kang Seok-Min, Lennie Terry A
机构信息
Eun Kyeung Song, PhD, RN Assistant Professor, Department of Nursing, College of Medicine, University of Ulsan, Korea. Yongjik Lee, MD Assistant Professor, Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Ulsan, Ulsan University Hospital, Korea. Debra K. Moser, DNSc, RN Professor, College of Nursing, University of Kentucky, Lexington. Rebecca L. Dekker, PhD, APRN Assistant Professor, College of Nursing, University of Kentucky, Lexington. Seok-Min Kang, MD, PhD Professor, Cardiology Division, Severance Hospital, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Seoul, Korea. Terry A. Lennie, PhD, RN Professor, College of Nursing, University of Kentucky, Lexington.
出版信息
J Cardiovasc Nurs. 2014 Sep-Oct;29(5):439-47. doi: 10.1097/JCN.0b013e3182a46ba8.
BACKGROUND
Patients with heart failure (HF) commonly have unintentional weight loss, depressive symptoms, and elevated levels of high-sensitivity C-reactive protein (hsCRP). Each of these variables has been independently associated with shorter cardiac event-free survival. However, little data exist on the relationships of unintentional weight loss, hsCRP level, and depressive symptoms to cardiac event-free survival.
OBJECTIVE
The aims of this study were to determine (1) whether depressive symptoms and elevated hsCRP level predicted unintentional weight loss and (2) whether unintentional weight loss predicted shorter cardiac event-free survival.
METHODS
This was a prospective study of 243 consecutive HF patients (61% men, 61 ± 14 years old) enrolled during an index hospitalization for HF exacerbation. Patients provided blood samples to measure hsCRP level and completed the Beck Depression Inventory to assess depressive symptoms at discharge. Body weight was measured at discharge and 6 months later. Unintentional weight loss was defined as weight loss of greater than 6% of body weight since discharge. Cardiac event-free survival was followed for 1 year after the second measurement of body weight through monthly telephone interviews. Hierarchical logistic regression was used to determine whether depressive symptoms and elevated hsCRP level predicted unintentional weight loss. Cox hazard regression was used to determine whether unintentional weight loss predicted cardiac event-free survival.
RESULTS
Thirty-five patients (14.4%) experienced unintentional weight loss at 6 months after discharge. Hierarchical Cox hazard regression revealed that patients with unintentional weight loss had a 3.2 times higher risk for cardiac events, adjusting for other clinical factors (P < .001). In hierarchical logistic regression, elevated hsCRP level (odds ratio, 1.49; 95% confidence interval, 1.15-1.92) and depressive symptoms (odds ratio, 1.07, 95% confidence interval, 1.02-1.12) independently predicted unintentional weight loss.
CONCLUSIONS
Unintentional weight loss was an independent predictor of poor outcomes. Heart failure patients with depressive symptoms and elevated hsCRP levels are at a higher risk for unintentional weight loss.
背景
心力衰竭（HF）患者通常会出现非故意体重减轻、抑郁症状以及高敏C反应蛋白（hsCRP）水平升高。这些变量中的每一个都与较短的无心脏事件生存期独立相关。然而，关于非故意体重减轻、hsCRP水平和抑郁症状与无心脏事件生存期之间关系的数据很少。
目的
本研究的目的是确定（1）抑郁症状和hsCRP水平升高是否可预测非故意体重减轻，以及（2）非故意体重减轻是否可预测较短的无心脏事件生存期。
方法
这是一项对243例因HF加重而住院的连续HF患者（61%为男性，61±14岁）进行的前瞻性研究。患者提供血样以测量hsCRP水平，并在出院时完成贝克抑郁量表以评估抑郁症状。在出院时和6个月后测量体重。非故意体重减轻定义为自出院以来体重减轻超过体重的6%。在第二次测量体重后的1年里，通过每月电话访谈随访无心脏事件生存期。采用分层逻辑回归确定抑郁症状和hsCRP水平升高是否可预测非故意体重减轻。采用Cox风险回归确定非故意体重减轻是否可预测无心脏事件生存期。
结果
35例患者（14.4%）在出院后6个月出现非故意体重减轻。分层Cox风险回归显示，在调整其他临床因素后，非故意体重减轻的患者发生心脏事件的风险高3.2倍（P<.001）。在分层逻辑回归中，hsCRP水平升高（比值比，1.49；95%置信区间，1.15-1.92）和抑郁症状（比值比，1.07，95%置信区间，1.02-1.12）独立预测非故意体重减轻。
结论
非故意体重减轻是不良预后的独立预测因素。有抑郁症状和hsCRP水平升高的心力衰竭患者非故意体重减轻的风险更高。
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