Imamura Teruhiko, Kinugawa Koichiro, Nitta Daisuke, Inaba Toshiro, Maki Hisataka, Hatano Masaru, Kinoshita Osamu, Nawata Kan, Kyo Shunei, Ono Minoru
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Artif Organs. 2015 Jun;18(2):120-7. doi: 10.1007/s10047-015-0816-2. Epub 2015 Jan 21.
Survival in patients with continuous flow left ventricular assist device (CF LVAD) had been increased owing to improved perioperative management procedures. The second target for successful long-term LVAD treatment was to reduce readmission especially due to device-specific infection, which was one of the major unsolved complications. Among 57 enrolled patients who had received CF LVAD and been followed for 530 days on median at our institute between 2008 and 2014, 21 patients experienced readmission due to driveline infection (DLI) at 190 days after the surgery on median. Considering the result of Uni/Multivariate Cox regression analyses demonstrating lower serum albumin concentration (S-ALB) (hazard ratio 0.144) and body mass index (BMI) (hazard ratio 0.843) both obtained at discharge were independent predictors of readmission due to DLI, we constructed a New Score "7 × [S-ALB (g/dL)] + [BMI]", which significantly stratified readmission-free rate into 3 groups [low (>50 Pt), intermediate (44-50 Pt), and high risk group (<44 Pt)] during 2-year study period (p = 0.008). Survival remained unchanged irrespective of DLI, whereas those with DLI needed longer in-hospital treatment (p < 0.05). In conclusion, readmission due to DLI could be predicted by using two simple nutrition parameters at discharge. Early nutrition assessment and intervention may reduce readmission and improve patients' quality of life during long-term LVAD support.
由于围手术期管理程序的改进,持续血流左心室辅助装置(CF LVAD)患者的生存率有所提高。长期成功进行LVAD治疗的第二个目标是减少再入院,尤其是因装置特异性感染导致的再入院,这是主要的未解决并发症之一。在2008年至2014年期间,我们研究所对57例接受CF LVAD并进行了中位时间530天随访的患者进行了研究,其中21例患者在术后中位时间190天因驱动线感染(DLI)再次入院。考虑到单因素/多因素Cox回归分析结果显示,出院时较低的血清白蛋白浓度(S-ALB)(风险比0.144)和体重指数(BMI)(风险比0.843)是因DLI再次入院的独立预测因素,我们构建了一个新的评分“7×[S-ALB(g/dL)]+[BMI]”,在2年的研究期内,该评分将无再入院率显著分为3组[低风险(>50分)、中风险(44-50分)和高风险组(<44分)](p=0.008)。无论是否发生DLI,生存率均保持不变,而发生DLI的患者需要更长的住院治疗时间(p<0.05)。总之,出院时使用两个简单的营养参数可以预测因DLI导致的再入院。早期营养评估和干预可能会减少再入院,并改善长期LVAD支持期间患者的生活质量。