Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
J Cardiol. 2021 Feb;77(2):147-153. doi: 10.1016/j.jjcc.2020.10.008. Epub 2020 Oct 22.
Malnutrition has been reported to be associated with worse clinical outcomes in various cardiovascular diseases. We aimed to investigate the clinical significance of the nutritional status in atrial fibrillation (AF) patients aged 80 years and over receiving oral anticoagulants (OACs), focusing on the difference between direct OACs (DOACs) and warfarin treatment.
This was a retrospective and observational study. We enrolled 332 consecutive AF patients aged 80 years and over who were treated with OACs: DOACs (n = 256) and warfarin (n = 76). A controlling nutritional status (CONUT) score was used to evaluate the nutritional status. The enrolled patients were divided into two groups based on the CONUT score: CONUT score <5 (n = 239) and CONUT score ≥5 (n = 93) groups. We investigated the relationship between the nutritional status and clinical outcomes.
The CONUT score ≥5 group had significantly higher incidence of major bleeding (MB) compared to the CONUT score <5 group (4.6/100 person-years vs. 0.7/100 person-years, p < 0.01). On Cox hazard analysis, CONUT score ≥5 group was significantly associated with increased MB compared with the CONUT score <5 group (hazard ratio: 5.80, 95% confidence interval: 1.44-23.33, p = 0.013). In the DOAC group, the incidence of MB did not differ between the CONUT score ≥5 and CONUT score <5 groups (p = 0.54). In the warfarin group, MB occurred more frequently in the CONUT score ≥5 group than CONUT score <5 group (p < 0.01). There was no significant difference in the incidence of thromboembolic events between the CONUT score ≥5 and CONUT score <5 groups in both the DOAC and warfarin groups.
The prognostic values of the nutritional status based on the CONUT score for MB differed between AF patients aged 80 years and over receiving DOACs and those receiving warfarin. It may be favorable to use DOACs to avoid bleeding events in those with malnutrition.
营养不良与各种心血管疾病的临床结局恶化有关。我们旨在研究 80 岁及以上接受口服抗凝剂（OAC）治疗的心房颤动（AF）患者的营养状况的临床意义，重点关注直接口服抗凝剂（DOAC）与华法林治疗之间的差异。
这是一项回顾性和观察性研究。我们纳入了 332 名连续接受 OAC 治疗的 80 岁及以上的 AF 患者：DOAC（n=256）和华法林（n=76）。使用控制营养状况（CONUT）评分评估营养状况。根据 CONUT 评分将入组患者分为两组：CONUT 评分<5（n=239）和 CONUT 评分≥5（n=93）组。我们研究了营养状况与临床结局之间的关系。
CONUT 评分≥5 组的大出血（MB）发生率明显高于 CONUT 评分<5 组（4.6/100 人年与 0.7/100 人年，p<0.01）。Cox 风险分析显示，与 CONUT 评分<5 组相比，CONUT 评分≥5 组的 MB 发生风险显著增加（风险比：5.80，95%置信区间：1.44-23.33，p=0.013）。在 DOAC 组中，CONUT 评分≥5 组与 CONUT 评分<5 组之间的 MB 发生率无差异（p=0.54）。在华法林组中，CONUT 评分≥5 组的 MB 发生率高于 CONUT 评分<5 组（p<0.01）。在 DOAC 和华法林组中，CONUT 评分≥5 组与 CONUT 评分<5 组的血栓栓塞事件发生率均无显著差异。
基于 CONUT 评分的营养状况对 80 岁及以上接受 DOAC 和华法林治疗的 AF 患者的 MB 预后价值不同。使用 DOAC 可能有利于避免营养不良患者的出血事件。
