Kumada Yoshitaka, Ishii Hideki, Oshima Satoru, Ito Ryuta, Umemoto Norio, Takahashi Hiroshi, Murohara Toyoaki
Cardiovascular Surgery, Matsunami General Hospital, Hashima-gun, Gifu, Japan.
Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Open Heart. 2020 Jul;7(2). doi: 10.1136/openhrt-2020-001276.
Protein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients.
We enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):<91.5, T2: 91.5-98.1 and T3:>98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5-7.0 mg/L and T3:≥7.1 mg/L).
Kaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). Declined GNRI (HR 2.40, 95% CI 1.58 to 3.74, p<0.0001 for T1 vs T3) and elevated CRP (HR 2.31, 95% CI 1.58 to 3.43, p<0.0001 for T3 vs T1) were identified as independent predictors of mortality. In combined setting of both variables, risk of mortality was 5.55 times higher (95% CI 2.64 to 13.6, p<0.0001) in T1 of GNRI with T3 of CRP than in T3 of GNRI with T1 of CRP. Addition of GNRI and CRP in a model with established risk factors improved C-statistics (0.648 to 0.724, p<0.0001) greater than that of each alone.
Preprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.
蛋白质 - 能量消耗与血液透析（HD）患者的慢性炎症和晚期动脉粥样硬化相关。我们研究了老年营养风险指数（GNRI）、C反应蛋白（CRP）与慢性HD患者冠状动脉血运重建术后死亡率预测之间的关联。
我们纳入了721例择期接受冠状动脉血运重建的HD患者。根据术前GNRI水平（三分位数1（T1）：<91.5，T2：91.5 - 98.1，T3：>98.1）和CRP水平（T1：≤1.4 mg/L，T2：1.5 - 7.0 mg/L，T3：≥7.1 mg/L）将他们分为三分位数。
GNRI的T1、T2和T3组的Kaplan - Meier 10年生存率分别为32.3%、44.8%和72.5%，CRP的T1、T2和T3组分别为60.9%、49.2%和23.5%（两者均p<0.0001）。GNRI下降（风险比[HR] 2.40，95%置信区间[CI] 1.58至3.74，T1与T3相比p<0.0001）和CRP升高（HR 2.31，95% CI 1.58至3.43，T3与T1相比p<0.0001）被确定为死亡率的独立预测因素。在两个变量的联合情况下，GNRI的T1与CRP的T3组合的死亡风险比GNRI的T3与CRP的T1组合高5.55倍（95% CI 2.64至13.6，p<0.0001）。在具有既定风险因素的模型中加入GNRI和CRP可提高C统计量（从0.648提高到0.724，p<0.0001），且比单独加入每个变量时提高得更多。
术前GNRI下降和CRP升高与慢性HD患者冠状动脉血运重建术后死亡率密切相关。此外，两个变量的组合不仅可对死亡风险进行分层，还可提高预测能力。
