Department of Anesthesiology and Intensive Care, Saint Petersburg State University Hospital, St. Petersburg, Russian Federation.
Quality of Life and Monitoring Unit, Saint Petersburg State University Hospital, St. Petersburg, Russian Federation.
Nutrition. 2021 Mar;83:111057. doi: 10.1016/j.nut.2020.111057. Epub 2020 Nov 14.
The aim of this study was to investigate the relationship between malnutrition and long-term survival in patients who underwent cardiopulmonary bypass (CPB).
This study analyzed the long-term survival data of a mixed cohort of 1187 cardiac patients previously enrolled in a prospective observational study of nutritional screening in cardiac surgery. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST). The mean age of patients was 58.86 ± 10.07 y (95% confidence interval [CI], 58.2-59.4). The median time of follow-up was 73.4 mo (25th-75th percentiles, 18.3-101.3).
In all, 449 patients (37.8%) were lost to follow-up after hospitalization. For the remaining participants, the overall 8-y survival was 68% (95% CI, 59-76) and 77% (95% CI, 73-80; log-rank, P = 0.12) in patients with and without malnutrition risk, respectively. Statistically significant differences in survival were found during the 3-y follow-up of patients with heart valve disease: 83% (95% CI, 74-92) with malnutrition versus 93% (95% CI, 90-96) without malnutrition (log-rank, P = 0.03). The final multivariate Cox regression model revealed logistic EuroSCORE (hazard ratio (HR), 1.337; 95% CI, 1.110-1.612), cardiopulmonary bypass time <110.5 min (HR 0.463, 95% CI 0.255-0.842), preoperative albumin (HR 0.799, 95% CI 0.691-0.924), and C-reactive protein (HR, 1.106; 95% CI, 1.018-1.202) as independent predictors of 3-y survival.
Preoperative malnutrition is not associated with 8-y mortality in a mixed cardiac surgery cohort. However, it may be associated with worse 3-y outcomes in patients with heart valve disease.
本研究旨在探讨体外循环（CPB）患者营养不良与长期生存之间的关系。
本研究分析了先前纳入心脏手术营养筛查前瞻性观察研究的 1187 例心脏混合队列患者的长期生存数据。使用营养不良通用筛查工具（MUST）评估营养状况。患者平均年龄为 58.86±10.07 岁（95%置信区间[CI]，58.2-59.4）。中位随访时间为 73.4 个月（25%-75%，18.3-101.3）。
共有 449 例患者（37.8%）在住院后失访。对于其余参与者，总体 8 年生存率为 68%（95%CI，59-76），营养不良风险患者分别为 77%（95%CI，73-80；对数秩检验，P=0.12）。在患有心脏瓣膜疾病的患者中，3 年随访时生存差异有统计学意义：营养不良者为 83%（95%CI，74-92），无营养不良者为 93%（95%CI，90-96）（对数秩检验，P=0.03）。最终的多变量 Cox 回归模型显示逻辑 EuroSCORE（危险比（HR），1.337；95%CI，1.110-1.612）、CPB 时间<110.5 分钟（HR 0.463，95%CI 0.255-0.842）、术前白蛋白（HR 0.799，95%CI 0.691-0.924）和 C-反应蛋白（HR，1.106；95%CI，1.018-1.202）是 3 年生存率的独立预测因素。
在混合心脏手术队列中，术前营养不良与 8 年死亡率无关。然而，它可能与心脏瓣膜疾病患者 3 年预后较差有关。
