School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, 100730, Beijing, China.
Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100045, Beijing, China.
Nutr Metab Cardiovasc Dis. 2022 Jun;32(6):1361-1374. doi: 10.1016/j.numecd.2022.03.009. Epub 2022 Mar 14.
In the absence of a gold standard or scientific consensus regarding the nutritional evaluation of heart failure (HF) patients, this study aimed to summarize and systematically evaluate the prognostic value of nutritional screening and assessment tools used for all-cause mortality in HF patients.
Relevant studies were retrieved from major databases (PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, and China Biology Medicine disc (CMB)) and searched from the earliest available date until July 2021. If three or more studies used the same tool, meta-analysis using RevMan 5.3 was performed. This systematic review was registered at PROSPERO (number CRD42021275575). A total of 36 articles involving 25,141 HF patients were included for qualitative analysis and 31 studies for quantitative analysis. Meta-analysis of these studies indicated, poor nutritional status evaluated by using 5 nutritional screening tools (Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status Score (CONUT), Nutritional Risk Index (NRI), and Short Form Mini Nutritional Assessment (MNA-SF)) or 2 nutritional assessment tools (the Mini Nutritional Assessment (MNA) and Generated Subjective Global Assessment (SGA)) predicted all-cause mortality in HF patients. Of all tools analyzed, MNA had the maximum HR for mortality [HR = 2.62, 95%CI 1.11-6.20, P = 0.03] and MNA-SF [HR = 1.94, 95%CI 1.40-2.70, P＜0.001] was the best nutritional screening tools.
Poor nutritional status predicted all-cause mortality in HF patients. MNA may be the best nutritional assessment tool, and MNA-SF is most recommended for HF patient nutritional screening. The application value of MNA, especially in patients with reduced left ventricular ejection fraction (LVEF), needs to be further confirmed. The clinical application value of Mini-Nutrition Assessment Special for Heart Failure (MNA-HF) and Global Leadership Initiative on Malnutrition (GLIM) in HF patients needs to be confirmed.
由于缺乏关于心力衰竭（HF）患者营养评估的金标准或科学共识，本研究旨在总结和系统评估用于评估 HF 患者全因死亡率的营养筛查和评估工具的预后价值。
从主要数据库（PubMed、Embase、Web of Science、中国知网（CNKI）、万方数据和中国生物医学文献数据库（CMB））中检索相关研究，并从最早的可用日期检索到 2021 年 7 月。如果有三个或更多研究使用相同的工具，则使用 RevMan 5.3 进行荟萃分析。本系统评价在 PROSPERO（注册号 CRD42021275575）上进行了注册。共纳入 36 项研究，涉及 25141 例 HF 患者，进行定性分析，31 项研究进行定量分析。这些研究的荟萃分析表明，使用 5 种营养筛查工具（预后营养指数（PNI）、老年营养风险指数（GNRI）、控制营养状态评分（CONUT）、营养风险指数（NRI）和简易营养评估量表（MNA-SF））或 2 种营养评估工具（简易营养评估量表（MNA）和主观整体评估（SGA））评估的营养不良状态预测 HF 患者的全因死亡率。在所有分析的工具中，MNA 的死亡率最大 HR [HR=2.62，95%CI 1.11-6.20，P=0.03]，MNA-SF [HR=1.94，95%CI 1.40-2.70，P＜0.001]是最佳的营养筛查工具。
营养不良状态预测 HF 患者的全因死亡率。MNA 可能是最佳的营养评估工具，MNA-SF 是 HF 患者营养筛查的最佳推荐工具。MNA 的临床应用价值，特别是在左心室射血分数（LVEF）降低的患者中，需要进一步证实。简易心力衰竭营养评估量表（MNA-HF）和全球营养不良倡议（GLIM）在 HF 患者中的临床应用价值需要进一步证实。
