Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
Department of cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan.
Nagoya J Med Sci. 2021 Feb;83(1):93-105. doi: 10.18999/nagjms.83.1.93.
This study aimed to evaluate the impact of serial changes in nutritional status on 1-year events including all-cause mortality or rehospitalization owing to heart failure (HF) among hospitalized patients with acute decompensated HF (ADHF). The study subjects comprised 253 hospitalized patients with ADHF. The controlling nutritional status (CONUT) score was assessed both at hospital admission and discharge. The subjects were divided into three groups according to nutritional status using CONUT score: normal (0 and 1), mild risk (2-4), and moderate to severe risk defined as malnutrition (5-12). We observed nutritional status was improved or not. The incidence of malnutrition was 30.4% at hospital admission and 23.7% at discharge, respectively. Malnutrition was independently associated with 1-year events among hospitalized patients with ADHF. Presence or absence of improvement in nutritional status was significantly associated with 1-year events ( < 0.05), that was independent of percentage change in plasma volume in multivariate Cox regression analyses. We determined a reference model, including gender and estimated glomerular filtration rate, using multivariate logistic regression analysis ( < 0.05). Adding the absence of improvement in nutritional status during hospitalization to the reference model significantly improved both NRI and IDI (0.563, < 0.001 and 0.039, = 0.001). Furthermore, malnutrition at hospital discharge significantly improved NRI (0.256, = 0.036) In conclusion, serial changes in the nutritional status evaluated on the basis of multiple measurements may provide more useful information to predict 1-year events than single measurement at hospital admission or discharge in hospitalized patients with ADHF.
本研究旨在评估营养状况的连续变化对急性失代偿性心力衰竭（ADHF）住院患者 1 年事件（包括全因死亡率或因心力衰竭再住院）的影响。研究对象包括 253 例 ADHF 住院患者。在入院和出院时评估了控制营养状况（CONUT）评分。根据 CONUT 评分将患者分为三组：营养正常（0 分和 1 分）、轻度风险（2-4 分）和中重度风险（定义为营养不良，5-12 分）。我们观察了营养状况是否得到改善。入院时营养不良的发生率为 30.4%，出院时为 23.7%。营养不良与 ADHF 住院患者的 1 年事件独立相关。营养状况的改善或恶化与 1 年事件显著相关（ < 0.05），这在多变量 Cox 回归分析中独立于血浆容量的百分比变化。我们使用多变量逻辑回归分析确定了一个包含性别和估计肾小球滤过率的参考模型（ < 0.05）。在参考模型中加入住院期间营养状况的改善与否，显著提高了 NRI 和 IDI（0.563， < 0.001 和 0.039， = 0.001）。此外，出院时的营养不良显著提高了 NRI（0.256， = 0.036）。总之，基于多次测量评估的营养状况的连续变化可能比 ADHF 住院患者单次入院或出院时的单一测量提供更有用的信息来预测 1 年事件。
