Department of Emergency Medicine.
Department of Cardiology, Faculty of Medicine, Muğla Sitki Koçman University, Muğla, Turkey.
Eur J Emerg Med. 2020 Oct;27(5):362-367. doi: 10.1097/MEJ.0000000000000690.
The association between objective nutritional indexes and prognosis in patients with acute heart failure have not been well studied. Therefore, we aimed to compare the prognostic value of modified Glasgow prognostic score, prognostic nutritional index, controlling nutritional status score, and geriatric nutritional risk index for the prediction of in-hospital mortality in patients with acute heart failure.
All consecutive elderly patients (aged ≥65 years) who had tests for C-reactive protein, total lymphocyte count, total cholesterol, and albumin levels at admission, and hospitalized due to acute heart failure were retrospectively included. The primary endpoint of the study was in-hospital mortality. We used a base model for the prediction of in-hospital mortality, including age, gender, log N-terminal pro-B-type natriuretic peptide, and the presence of coronary artery disease. We added each of the malnutrition scores, in turn, to the base model and used C-statistics to evaluate model discrimination in survival analysis.
A total of 628 patients were included, and 80 (12.7%) of the patients died during the hospital stay. Multivariate analysis showed that older age, prognostic nutritional index < 41.2, controlling nutritional status score > 5, geriatric nutritional risk index <92, and modified Glasgow prognostic score were independent predictors of in-hospital mortality. Among the malnutrition scores, geriatric nutritional risk index increased model performance most compared with base model.
Though all objective nutritional indexes were associated with prognosis in elderly patients with acute heart failure, geriatric nutritional risk index was superior to other scores in predicting in-hospital mortality.
客观营养指标与急性心力衰竭患者预后之间的关系尚未得到很好的研究。因此，我们旨在比较改良格拉斯哥预后评分、预后营养指数、控制营养状况评分和老年营养风险指数对预测急性心力衰竭住院患者院内死亡率的预后价值。
回顾性纳入所有连续就诊的老年（年龄≥65 岁）患者，这些患者入院时检测了 C 反应蛋白、总淋巴细胞计数、总胆固醇和白蛋白水平，并因急性心力衰竭住院。本研究的主要终点是院内死亡率。我们使用包含年龄、性别、N 端脑利钠肽前体对数和冠状动脉疾病的基础模型预测院内死亡率。我们依次向基础模型中添加每个营养不良评分，并使用 C 统计量评估生存分析中的模型区分度。
共纳入 628 例患者，80 例（12.7%）患者在住院期间死亡。多变量分析显示，年龄较大、预后营养指数<41.2、控制营养状况评分>5、老年营养风险指数<92 和改良格拉斯哥预后评分是院内死亡率的独立预测因素。在营养不良评分中，老年营养风险指数与基础模型相比，提高了模型性能。
虽然所有客观营养指标均与老年急性心力衰竭患者的预后相关，但老年营养风险指数在预测院内死亡率方面优于其他评分。
