Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, y CIBERCV, Salamanca, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago de Compostela (IDICHUS), y CIBERCV, Santiago de Compostela, Spain.
Hospital Clínico Universitario Virgen de la Victoria de Málaga, Málaga, Spain.
Int J Cardiol. 2019 Feb 1;276:66-71. doi: 10.1016/j.ijcard.2018.11.097. Epub 2018 Nov 17.
Among patients undergoing transcatheter aortic valve replacement (TAVR), prognosis is impacted by nutritional status, but the influence of the nutritional risk index (NRI) is unknown. Here we calculated the NRI to determine the prevalence and prognostic impact in terms of mortality of malnutrition in TAVR patients.
This retrospective multicenter study included 941 patients who underwent TAVR between 2008 and 2016 (mean age, 80.7 ± 6.5 years; 57% female). The NRI was calculated as 1.519 × albumin (g/L) + 41.7 × (real weight [kg] / ideal weight [kg]). The mean NRI was 98.1 ± 7.0%. The patients were stratified into the following groups based on malnutrition risk: severe (NRI < 83.5; n = 83; 8.82%), moderate (83.5 ≥ NRI < 97.5; n = 370; 39.32%), mild (97.5 ≥ NRI < 100; n = 102; 10.84%), and no risk (NRI ≥ 100; n = 386; 41.02%). During the follow-up period (2.1 ± 1.1 years), 186 patients died, representing 19.8% of the total cohort. Cox regression models were used to analyze the relationship between NRI and mortality during follow-up. Compared to patients with no or mild nutritional risk, those with moderate or severe nutritional risk had a 45% greater risk of mortality during follow-up (adjusted HR, 1.45; 95% CI, 1.05-1.99; P = 0.021).
Malnutrition is common among TAVR patients. Our present data indicated that the NRI was independently associated with increased risk of death during long-term follow-up after TAVR. Based on its potential to improve risk prediction, NRI appears to be a promising tool for the clinical assessment of patients who are candidates for TAVR.
在接受经导管主动脉瓣置换术（TAVR）的患者中，营养状况会影响预后，但营养风险指数（NRI）的影响尚不清楚。在这里，我们计算了 NRI，以确定 TAVR 患者中营养不良的患病率及其对死亡率的预后影响。
这是一项回顾性多中心研究，纳入了 2008 年至 2016 年间接受 TAVR 的 941 例患者（平均年龄 80.7±6.5 岁；57%为女性）。NRI 计算方法为 1.519×白蛋白（g/L）+41.7×（实际体重[kg]/理想体重[kg]）。NRI 的平均值为 98.1±7.0%。根据营养不良风险，患者被分为以下组：严重组（NRI<83.5；n=83；8.82%）、中度组（83.5≤NRI<97.5；n=370；39.32%）、轻度组（97.5≤NRI<100；n=102；10.84%）和无风险组（NRI≥100；n=386；41.02%）。在随访期间（2.1±1.1 年），186 例患者死亡，占总队列的 19.8%。采用 Cox 回归模型分析 NRI 与随访期间死亡率之间的关系。与无或轻度营养风险的患者相比，中度或重度营养风险的患者在随访期间死亡的风险增加了 45%（调整后的 HR，1.45；95%CI，1.05-1.99；P=0.021）。
营养不良在 TAVR 患者中很常见。我们的研究数据表明，NRI 与 TAVR 后长期随访期间的死亡风险增加独立相关。基于其改善风险预测的潜力，NRI 似乎是评估 TAVR 候选患者的一种有前途的工具。
