Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan.
Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan.
PLoS One. 2022 May 19;17(5):e0266839. doi: 10.1371/journal.pone.0266839. eCollection 2022.
Although it is known that assessment and management of the nutritional status of patients are important for treatment of patients with heart failure (HF), there are currently no established indicators. Therefore, we investigated the effects of nutritional parameters as well as conventional parameters on the prognosis of HF patients. A total of 1954 consecutive HF patients with left ventricular ejection fraction (LVEF) less than 50% were enrolled in this study. Transthoracic echocardiography was performed and conventional parameters for HF patients and parameters to assess nutritional status were measured in all patients. Patients were followed up with a primary endpoint of lethal cardiac events (CEs) for 30.2 months. During the follow-up period, cardiac events were documented in 619 HF patients. The CEs group had a lower level of cholinesterase (201.5U/L vs 265.2U/L, P <0.0001), lower estimated GFR (35.2 ml/min/1.73m2 vs 50.3ml/min/1.73m2, P< 0.0001), and lower Geriatric Nutritional Risk Index (GNRI) (91.9 vs 100.0, P< 0.0001) than those in the non-CEs group. Serum cholinesterase, estimated GFR, and GNRI were identified as significant prognostic determinants in multivariate analysis. ROC analyses revealed cut-off values of serum cholinesterase, estimated GFR, and GNRI of 229U/L, 34.2 ml/min/1.73m2, and 95.6, respectively, for identifying high-risk HF patients. HF patients with serum cholinesterase< 229U/L, estimated GFR<34.3 ml/min/1.73m2, and GNRI< 95.6 had a significantly greater rate of CEs than that in the other patients (P<0.0001). Low serum cholinesterase and low GNRI can predict cardiac mortality risk in systolic HF patients with renal dysfunction.
虽然评估和管理心力衰竭（HF）患者的营养状况对于治疗 HF 患者很重要，但目前还没有确定的指标。因此，我们研究了营养参数以及常规参数对 HF 患者预后的影响。本研究共纳入 1954 例左心室射血分数（LVEF）<50%的连续 HF 患者。所有患者均行经胸超声心动图检查，并测量 HF 患者的常规参数和评估营养状况的参数。以致死性心脏事件（CEs）为主要终点，对患者进行 30.2 个月的随访。在随访期间，有 619 例 HF 患者发生心脏事件。CEs 组患者的胆碱酯酶水平较低（201.5U/L vs 265.2U/L，P<0.0001）、估算肾小球滤过率（eGFR）较低（35.2ml/min/1.73m2 vs 50.3ml/min/1.73m2，P<0.0001）、老年营养风险指数（GNRI）较低（91.9 vs 100.0，P<0.0001）。多变量分析显示，血清胆碱酯酶、eGFR 和 GNRI 是显著的预后决定因素。ROC 分析显示，血清胆碱酯酶、eGFR 和 GNRI 的截断值分别为 229U/L、34.2ml/min/1.73m2 和 95.6，用于识别 HF 高危患者。血清胆碱酯酶<229U/L、eGFR<34.3ml/min/1.73m2 和 GNRI<95.6 的 HF 患者的 CEs 发生率明显高于其他患者（P<0.0001）。低血清胆碱酯酶和低 GNRI 可预测肾功能不全的收缩性 HF 患者的心脏死亡风险。
