Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK.
Department of Cardiology, Diana, Princess of Wales Hospital, Grimsby, Northeast Lincolnshire, DN33 2BA, UK.
Clin Res Cardiol. 2017 Jul;106(7):533-541. doi: 10.1007/s00392-017-1082-5. Epub 2017 Feb 15.
Frailty and malnutrition are common in patients with heart failure (HF), and are associated with adverse outcomes. We studied the prognostic value of three malnutrition and three frailty indices in patients admitted acutely to hospital with HF.
265 consecutive patients [62% males, median age 80 (interquartile range (IQR): 72-86) years, median NTproBNP 3633 (IQR: 2025-6407) ng/l] admitted with HF between 2013 and 2014 were enrolled. Patients were screened for frailty using the Derby frailty index (DFI), acute frailty network (AFN) frailty criteria, and clinical frailty scale (CFS) and for malnutrition using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and prognostic nutritional index (PNI).
According to the CFS (> 4), DFI, and AFN, 53, 50, and 53% were frail, respectively. According to the GNRI (≤ 98), CONUT score (> 4), and PNI (≤ 38), 46, 46, and 42% patients were malnourished, respectively. During a median follow-up of 598 days (IQR 319-807 days), 113 patients died. One year mortality was 1% for those who were neither frail nor malnourished; 15% for those who were either malnourished or frail; and 65% for those who were both malnourished and frail. Amongst the malnutrition scores, PNI, and amongst the frailty scores, CFS increased model performance most compared with base model. A final model, including CFS and PNI, increased c-statistic for mortality prediction from 0.68 to 0.84.
Worsening frailty and malnutrition indices are strongly related to worse outcome in patients hospitalised with HF.
衰弱和营养不良在心力衰竭（HF）患者中很常见，并且与不良结局相关。我们研究了三种营养不良和三种衰弱指数在因 HF 急性入院的患者中的预后价值。
2013 年至 2014 年间共纳入 265 例连续患者（62%为男性，中位年龄 80（四分位距（IQR）：72-86）岁，中位 NTproBNP 3633（IQR：2025-6407）ng/L）。使用 Derby 衰弱指数（DFI）、急性衰弱网络（AFN）衰弱标准和临床衰弱量表（CFS）对患者进行衰弱筛查，使用老年营养风险指数（GNRI）、控制营养状态（CONUT）评分和预后营养指数（PNI）对患者进行营养不良筛查。
根据 CFS（>4）、DFI 和 AFN，分别有 53%、50%和 53%的患者衰弱。根据 GNRI（≤98）、CONUT 评分（>4）和 PNI（≤38），分别有 46%、46%和 42%的患者营养不良。中位随访 598 天（IQR 319-807 天）期间，113 例患者死亡。1 年死亡率分别为：既非衰弱也不营养不良者为 1%；衰弱或营养不良者为 15%；既衰弱又营养不良者为 65%。在营养不良评分中，PNI，以及在衰弱评分中，CFS 与基础模型相比，对死亡率的预测效果最佳。包含 CFS 和 PNI 的最终模型提高了死亡率预测的 C 统计量，从 0.68 提高到 0.84。
HF 住院患者的衰弱和营养不良指数恶化与预后不良密切相关。
