Lin Hong, Zhang Haifeng, Lin Zheng, Li Xinli, Kong Xiangqin, Sun Gouzhen
Nanjing Medical University School of Nursing, Nanjing, China.
Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
Heart Fail Rev. 2016 Sep;21(5):549-65. doi: 10.1007/s10741-016-9540-0.
Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.
近期研究表明，使用多维营养评估工具定义的营养不良可能会影响心力衰竭（HF）的临床结局。支持这种相关性的证据尚不清楚。因此，我们进行了这项系统评价，以严格评估多维评估工具在预测HF临床结局中的应用。我们对所有纳入的文章进行了描述性分析，包括定性分析。当识别出至少三项测试相同类型营养评估或筛查工具并使用相同结局的研究时，我们使用STATA进行荟萃分析。进行敏感性分析以验证我们的阳性结果。经过全面的文献检索和筛选，我们识别出17篇进行定性分析的文章和11篇进行定量分析的文章。我们确定HF患者中营养不良的患病率很高（范围为16%-90%），尤其是在晚期和急性失代偿性HF患者中（大致范围为75%-90%）。通过多维评估工具识别出的营养不良可能与住院、住院时间和并发症显著相关，尤其与高死亡率密切相关。荟萃分析显示，与其他工具相比，微型营养评定法（MNA）评分是HF患者死亡率最强的预测指标[风险比（HR）为4.32，95%置信区间为2.30-8.11]。进行敏感性分析后，我们的结果仍然可靠。HF患者中营养不良的患病率很高，尤其是在晚期和急性失代偿性HF患者中。此外，通过多维评估工具识别出的营养不良与HF患者的不良预后和高死亡率显著相关。
