Wu Li-Hung, Chiou Kuan-Rau, Pan I-Ju, Hsiao Shih-Hung
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung.
Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City.
Acta Cardiol Sin. 2021 May;37(3):269-277. doi: 10.6515/ACS.202105_37(3).20201123B.
This study aimed to investigate the relationship between malnutrition and outcomes in patients with decompensated severe systolic heart failure (HF) focusing on clinical presentations and medication use.
This study prospectively enrolled 108 patients admitted for severe systolic HF with a left ventricular (LV) ejection fraction < 35%, low cardiac output, and high LV filling pressure. Five patients died during the index hospitalization, and the remaining 103 patients were followed up for 2 years. The primary endpoints were HF rehospitalization and all-cause mortality. Nutritional risk index (NRI) was calculated as (1.519 × serum albumin, g/L) + (41.7 × body weight/ideal body weight).
Forty-four patients reached the study endpoints. An NRI ≤ 93 predicted events. The NRI ≤ 93 group had higher pulmonary artery systolic pressure, more edema over dependent parts, longer hospital stay, and more primary endpoints compared to the NRI > 93 group. The NRI ≤ 93 group received fewer evidence-based medications and more loop diuretics compared to the NRI > 93 group. NRI was an independent predictor of cardiovascular events [hazard ratio 0.902; 95% confidence interval (CI) 0.814-0.982 per 1 point increase; p = 0.012]. Low NRI was associated with a significantly higher use of loop diuretics [odds ratio (OR) 2.75; 95% CI 1.046-5.647; p = 0.004] and significantly lower use of beta blockers (OR 0.541; 95% CI 0.319-0.988; p = 0.002).
Malnutrition assessed using the NRI was associated with cardiovascular events in the patients with severe systolic HF with low cardiac output and high LV filling pressure. Low NRI was associated with more diuretic and less beta blocker use.
本研究旨在探讨失代偿性严重收缩性心力衰竭（HF）患者营养不良与预后之间的关系，重点关注临床表现和药物使用情况。
本研究前瞻性纳入了108例因严重收缩性HF入院的患者，这些患者左心室（LV）射血分数<35%，心输出量低，LV充盈压高。5例患者在首次住院期间死亡，其余103例患者随访2年。主要终点为HF再住院和全因死亡率。营养风险指数（NRI）计算公式为（1.519×血清白蛋白，g/L）+（41.7×体重/理想体重）。
44例患者达到研究终点。NRI≤93可预测事件发生。与NRI>93组相比，NRI≤93组肺动脉收缩压更高，下垂部位水肿更明显，住院时间更长，主要终点更多。与NRI>93组相比，NRI≤93组接受的循证药物更少，袢利尿剂更多。NRI是心血管事件的独立预测因子[风险比0.902；每增加1分的95%置信区间（CI）为0.814 - 0.982；p = 0.012]。低NRI与袢利尿剂的使用显著增加[比值比（OR）2.75；95% CI 1.046 - 5.647；p = 0.004]以及β受体阻滞剂的使用显著减少（OR 0.541；95% CI 0.319 - 0.988；p = 0.002）相关。
使用NRI评估的营养不良与低心输出量和高LV充盈压的严重收缩性HF患者的心血管事件相关。低NRI与更多的利尿剂使用和更少的β受体阻滞剂使用相关。
