Department of Internal Medicine, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain.
Department of Cardiology, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain.
Clin Nutr. 2018 Oct;37(5):1762-1764. doi: 10.1016/j.clnu.2017.07.009. Epub 2017 Jul 14.
BACKGROUND & AIMS: Hypoalbuminemia is common in acute heart failure (HF) patients and has been associated with increased hospital mortality and long-term mortality. Undernutrition is a factor causing hypoalbuminemia. The PICNIC study results show that a nutritional intervention in undernourished acute HF patients reduces the risks of all-cause death and of readmission for HF. We aimed to investigate whether the efficacy of a nutritional intervention is consistent among the subgroups of patients with and without hypoalbuminemia.
In PICNIC study, a total of 120 malnourished hospitalized patients due to acute HF were randomized to conventional HF treatment or conventional HF treatment combined with an individualized nutritional intervention. The primary endpoint was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. In this post-hoc sub-analysis we assessed the interaction of the effects of a nutritional intervention among patients with and without hypoalbuminemia. Analysis was by intention to treat.
59 (49,2%) patients demonstrated hypoalbuminemia and 61 (50,8%) had normalbuminemia. At 12 months, the number of events for the primary endpoint in the intervention group compared with the control group was consistent among patients with hypoalbuminemia (28.6% intervention vs 61.3% control, HR 0,35, 95% CI 0,15-0,81) and those without (25.8% intervention vs 60% control, HR 0,35, 95% CI 0,15-0,79; interaction p = 0,86).
There was no evidence that the relative efficacy of a nutritional intervention in undernourished acute HF patients was different between patients with normalbuminemia and those with hypoalbuminemia.
低白蛋白血症在急性心力衰竭（HF）患者中很常见，并且与住院死亡率和长期死亡率的增加有关。营养不良是导致低白蛋白血症的一个因素。PICNIC 研究结果表明，对营养不良的急性 HF 患者进行营养干预可降低全因死亡和 HF 再入院的风险。我们旨在研究在白蛋白正常和低白蛋白血症患者亚组中，营养干预的疗效是否一致。
在 PICNIC 研究中，共有 120 名因急性 HF 而营养不良的住院患者被随机分为常规 HF 治疗或常规 HF 治疗联合个体化营养干预。主要终点是全因死亡或因 HF 恶化而再入院的复合终点，随访时间最长为 12 个月。在这项事后亚分析中，我们评估了营养干预效果在白蛋白正常和低白蛋白血症患者中的相互作用。分析采用意向治疗。
59 名（49.2%）患者表现出低白蛋白血症，61 名（50.8%）患者白蛋白正常。在 12 个月时，与对照组相比，干预组的主要终点事件在低白蛋白血症患者（28.6%干预组比 61.3%对照组，HR 0.35，95%CI 0.15-0.81）和白蛋白正常患者（25.8%干预组比 60%对照组，HR 0.35，95%CI 0.15-0.79）中是一致的（交互作用 p=0.86）。
没有证据表明营养干预对营养不良的急性 HF 患者的相对疗效在白蛋白正常和低白蛋白血症患者之间存在差异。
