Ishii Hideki, Takahashi Hiroshi, Ito Yasuhiko, Aoyama Toru, Kamoi Daisuke, Sakakibara Takashi, Umemoto Norio, Kumada Yoshitaka, Suzuki Susumu, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Department of Nephrology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan.
Nutrients. 2017 Apr 21;9(4):416. doi: 10.3390/nu9040416.
Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients. We investigated the association of abnormal ankle brachial index (ABI), PEW, and chronic inflammation status with clinical prognosis in HD patients. A total of 973 HD patients were enrolled and were followed-up for 8 years. As a marker of the PEW, geriatric nutritional risk index (GNRI) was used. Cut-off levels were 91.2 for GNRI defined from previous studies and 1.9 mg/L for C-reactive protein (CRP) as median value, respectively. Abnormal ABI was seen in 332 (34.1%) patients. Declined GNRI and elevated CRP levels were independently associated with abnormal ABI (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.96-0.99, = 0.0009 and OR 1.40, 95% CI 1.07-1.83, = 0.013, respectively). GNRI levels were also independently correlated with CRP levels (β = -0.126, < 0.0001). During follow-up period, 283 (29.1%) patients died, including 123 (12.6%) due to cardiovascular disease (CVD). Abnormal ABI (adjusted hazard ratio (HR) 1.62, 95% CI 1.13-2.32, = 0.0096), GNRI < 91.2 (adjusted HR 1.57, 95% CI 1.06-2.33, = 0.023) and CRP > 1.9 mg/L (adjusted HR 1.89, 95% CI 1.31-2.77, = 0.0007) independently predicted mortality due to CVD, respectively. In conclusion, abnormal ABI, GNRI, and CRP levels were closely associated with each other, and the combination of these variables increase their predictive values for the risk of mortality due to CVD and all-cause mortality in HD patients.
蛋白质能量消耗（PEW）在血液透析（HD）患者中非常普遍。我们研究了异常踝臂指数（ABI）、PEW和慢性炎症状态与HD患者临床预后的关联。共纳入973例HD患者，并进行了8年的随访。作为PEW的标志物，使用了老年营养风险指数（GNRI）。根据先前的研究，GNRI的临界值为91.2，C反应蛋白（CRP）的临界值为1.9mg/L（中位数）。332例（34.1%）患者存在异常ABI。GNRI降低和CRP水平升高与异常ABI独立相关（优势比（OR）分别为0.97，95%置信区间（CI）0.96 - 0.99，P = 0.0009和OR 1.40，95% CI 1.07 - 1.83，P = 0.013）。GNRI水平也与CRP水平独立相关（β = -0.126，P < 0.0001）。在随访期间，283例（29.1%）患者死亡，其中123例（12.6%）死于心血管疾病（CVD）。异常ABI（校正风险比（HR）1.62，95% CI 1.13 - 2.32，P = 0.0096）、GNRI < 91.2（校正HR 1.57，95% CI 1.06 - 2.33，P = 0.023）和CRP > 1.9mg/L（校正HR 1.89，95% CI 1.31 - 2.77，P = 0.0007）分别独立预测CVD导致的死亡率。总之，异常ABI、GNRI和CRP水平相互密切相关，这些变量的组合增加了它们对HD患者CVD导致的死亡风险和全因死亡率的预测价值。
