Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan.
Department of Cardiology, Kosei Hospital, Tokyo, Japan.
ESC Heart Fail. 2021 Dec;8(6):5372-5382. doi: 10.1002/ehf2.13629. Epub 2021 Oct 1.
The CONtrolling NUTritional status (CONUT) score represents the nutritional status of patients with heart failure (HF). Although high CONUT scores on admission are associated with increased risks of cardiovascular (CV) events in patients with HF, the impact of CONUT changes during hospitalization on their long-term prognosis is unclear. This study aimed to investigate the impact of CONUT score changes on the clinical outcomes of patients with HF after discharge.
This observational study included 1705 patients hospitalized with HF who were discharged alive. The patients were categorized depending on their CONUT scores at admission and discharge into persistently high, high at admission and normal at discharge, normal at admission and high at discharge, and persistently normal CONUT groups. The primary endpoint was a composite of CV death and readmission for HF after discharge. The primary endpoint occurred in 652 patients (38%) during the median 525 day follow-up period. Patients with persistently high CONUT scores had the highest composite endpoint rate (log-rank trend test: P < 0.001). After adjusting for covariates, the hazard ratio for the composite outcome was significantly lower for the patients with high CONUT scores at admission and normal CONUT scores at discharge than that for those with persistently high CONUT scores (hazard ratio: 0.69; 95% confidence interval: 0.49-0.98).
Nutritional status changes in patients with HF that occurred during hospitalization were associated with CV events after discharge. Improving the nutritional status of patients may improve their clinical outcomes.
CONtrolling NUTritional status(CONUT)评分代表心力衰竭(HF)患者的营养状况。尽管入院时高 CONUT 评分与 HF 患者心血管(CV)事件风险增加相关,但住院期间 CONUT 变化对其长期预后的影响尚不清楚。本研究旨在探讨出院后 HF 患者 CONUT 评分变化对其临床结局的影响。
本观察性研究纳入了 1705 例因 HF 出院存活的患者。根据入院和出院时的 CONUT 评分将患者分为持续高 CONUT、入院时高 CONUT 且出院时正常、入院时正常 CONUT 且出院时高 CONUT 和持续正常 CONUT 组。主要终点为出院后 CV 死亡和 HF 再入院的复合终点。在中位随访 525 天期间,主要终点在 652 例患者(38%)中发生。持续高 CONUT 评分患者的复合终点发生率最高(对数秩趋势检验:P<0.001)。在校正了混杂因素后,与持续高 CONUT 评分患者相比,入院时高 CONUT 评分且出院时正常 CONUT 评分患者的复合结局风险比显著降低(风险比:0.69;95%置信区间:0.49-0.98)。
HF 患者住院期间营养状况的变化与出院后 CV 事件相关。改善患者的营养状况可能改善其临床结局。