Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain; Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Department of Medical and Surgical Sciences, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Nutr Metab Cardiovasc Dis. 2021 Feb 8;31(2):481-488. doi: 10.1016/j.numecd.2020.09.026. Epub 2020 Sep 28.
Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown.
A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17-35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2-4.7) g/dL, the body mass index was 23 (21-27) kg/m, the NRI was 112 (106-118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5-10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04-1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17-8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93-0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration.
A low NRI is independently associated with a significant increased risk of MACE in CHD patients.
营养不良在慢性疾病中很常见，但其在成人先天性心脏病（CHD）患者中的患病率及其与疾病结局的关系尚不清楚。
对一个连续的 393 例稳定的先天性心脏病（CHD）患者的队列，在一个专门的临床单位进行了随访。研究了人口统计学、临床和实验室参数，以及营养风险指数（NRI），还研究了主要急性心血管事件（MACE），定义为动脉血栓事件、需要住院治疗的心力衰竭或心血管和非心血管死亡率。患者的中位年龄为 23 岁（17-35 岁），225 名（57%）为男性。中位血浆白蛋白浓度为 4.5（4.2-4.7）g/dL，体重指数为 23（21-27）kg/m2，NRI 为 112（106-118），33 名（8%）患者存在营养不良（NRI<100）。更差的纽约心脏协会（NYHA）功能分级（II 和 III）、总胆固醇和血清葡萄糖水平是与 CHD 患者营养不良（NRI<100）相关的显著危险因素。在中位 8（5-10）年的随访期间，39 名（10%）CHD 患者发生了 MACE。多变量 Cox 回归分析显示，年龄较大的患者（岁）[风险比（HR）1.06（1.04-1.09），p<0.001]、解剖结构复杂程度较大的 CHD 患者（HR 4.24（2.17-8.27），p<0.001）和 NRI 较低的患者（HR 0.95（0.93-0.98），p=0.001）的 MACE 无事件生存率显著较差，NRI 是 MACE 的更好预测因子，优于白蛋白浓度。
低 NRI 与 CHD 患者发生 MACE 的风险显著增加独立相关。
