Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, UK.
NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Am J Clin Nutr. 2021 Mar 11;113(3):695-705. doi: 10.1093/ajcn/nqaa311.
Malnutrition is common in patients with chronic heart failure (CHF) and is associated with adverse outcomes, but it is uncertain how malnutrition should best be evaluated.
This prospective cohort study aims to compare the short-term prognostic value of 9 commonly used malnutrition tools in patients with CHF.
We assessed, simultaneously, 3 simple tools [Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index], 3 multidimensional tools [Malnutrition Universal Screening Tool, Mini Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment], and 3 laboratory tests (serum cholesterol, albumin, and total lymphocyte count) in consecutive patients with CHF attending a routine follow-up. The primary end point was all-cause mortality; the secondary end point was the combination of all-cause hospitalization and all-cause mortality.
In total, 467 patients [67% male, median age 76 y (range: 21-98 y), median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1156 ng/L] were enrolled. During a median follow-up of 554 d, 82 (18%) patients died and 201 (43%) patients either had a nonelective hospitalization or died. In models corrected for age, hemoglobin (Hb), renal function, New York Heart Association (NYHA) class, NTproBNP, BMI, and comorbidities, all malnutrition tools, except total lymphocyte count and serum cholesterol, were independently associated with worse morbidity and mortality. A base model for predicting mortality, including age, NYHA class, log [NT-proBNP], Hb, renal function, and comorbidities, had a C-statistic of 0.757. CONUT (C-statistic = 0.777), among simple tools; MNA-SF (C-statistic = 0.776), among multidimensional tools; and albumin (C-statistic = 0.773), among biochemical tests, increased model performance most compared with the base model. Patients with serum albumin <30 g/L had a 6-fold increase in mortality compared with patients with albumin ≥35 g/L.
Malnutrition is strongly associated with adverse outcomes in patients with CHF. Measuring serum albumin provides comparable prognostic information to simple or multidimensional malnutrition tools.
慢性心力衰竭（CHF）患者常出现营养不良，且与不良预后相关，但目前尚不确定应如何最佳评估营养不良。
本前瞻性队列研究旨在比较 9 种常用营养不良工具在 CHF 患者中的短期预后价值。
我们同时评估了 3 种简单工具[控制营养状况（CONUT）评分、老年营养风险指数和预后营养指数]、3 种多维工具[营养不良通用筛查工具、微型营养评估-简短表格（MNA-SF）、主观全面评估]和 3 项实验室检查（血清胆固醇、白蛋白和总淋巴细胞计数）在连续就诊于常规随访的 CHF 患者中的情况。主要终点为全因死亡率；次要终点为全因住院和全因死亡率的联合终点。
共纳入 467 例患者[67%为男性，中位年龄 76 岁（范围：21-98 岁），中位 N 末端脑利钠肽前体（NT-proBNP）为 1156 ng/L]。中位随访 554 天期间，82 例（18%）患者死亡，201 例（43%）患者非计划性住院或死亡。在经年龄、血红蛋白（Hb）、肾功能、纽约心脏协会（NYHA）分级、NT-proBNP、BMI 和合并症校正的模型中，除总淋巴细胞计数和血清胆固醇外，所有营养不良工具均与更差的发病率和死亡率相关。包括年龄、NYHA 分级、log[NT-proBNP]、Hb、肾功能和合并症的预测死亡率的基础模型的 C 统计量为 0.757。在简单工具中，CONUT（C 统计量=0.777）；在多维工具中，MNA-SF（C 统计量=0.776）；在生化检查中，白蛋白（C 统计量=0.773）与基础模型相比，能更显著地提高模型性能。与白蛋白≥35 g/L 的患者相比，血清白蛋白<30 g/L 的患者死亡率增加了 6 倍。
营养不良与 CHF 患者的不良预后密切相关。测量血清白蛋白可提供与简单或多维营养不良工具相当的预后信息。
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