Cardiovascular Center, Anjo Kosei Hospital.
Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine.
Int Heart J. 2022;63(3):541-549. doi: 10.1536/ihj.21-809.
Undernutrition is very common among patients with heart failure (HF). This study evaluated the prognostic values of three nutritional risk/screening indices among patients with acute HF. We retrospectively calculated scores for 465 patients with acute HF using the Controlling Nutritional Status (CONUT) tool, the Geriatric Nutritional Risk Index (GNRI), and the Mini-Nutritional Assessment Short Form (MNA-SF). The outcomes of interest were the 1-year rate of cardiac events (cardiac-related death or HF-related readmission) and the Barthel index as an index of physical function during hospitalization. The CONUT, GNRI, and MNA-SF scores were significantly correlated, although the proportions of a normal nutritional state varied (CONUT: 18.3%, GNRI: 32.9%, and MNA-SF: 43.9%). Kaplan-Meier estimates revealed that cardiac events were more common among patients with undernutrition based on the CONUT score, and multivariable regression analysis revealed that only the CONUT score independently predicted poor outcomes. Furthermore, changes in the Barthel index during hospitalization were significantly correlated with the CONUT score but not with the GNRI and MNA-SF scores. In receiver operating characteristic analyses, the CONUT score had the most powerful predictive values on both the postdischarge incidence of cardiac events and the decline of physical function during hospitalization compared with the GNRI and the MNA-SF. These results indicate that the CONUT score might provide useful information for predicting poor outcomes in patients with acute HF.
营养不良在心力衰竭（HF）患者中非常普遍。本研究评估了三种营养风险/筛查指数在急性 HF 患者中的预后价值。我们回顾性地使用 Controlling Nutritional Status（CONUT）工具、老年营养风险指数（GNRI）和 Mini-Nutritional Assessment Short Form（MNA-SF）计算了 465 名急性 HF 患者的分数。感兴趣的结局是 1 年心脏事件（与心脏相关的死亡或 HF 相关的再入院）的发生率和住院期间作为身体功能指标的 Barthel 指数。尽管正常营养状态的比例不同（CONUT：18.3%，GNRI：32.9%和 MNA-SF：43.9%），但 CONUT、GNRI 和 MNA-SF 评分之间呈显著相关性。Kaplan-Meier 估计表明，根据 CONUT 评分，营养不良患者的心脏事件更为常见，多变量回归分析表明，只有 CONUT 评分独立预测不良结局。此外，住院期间 Barthel 指数的变化与 CONUT 评分显著相关，但与 GNRI 和 MNA-SF 评分无关。在接受者操作特征分析中，与 GNRI 和 MNA-SF 相比，CONUT 评分在预测急性 HF 患者出院后心脏事件发生率和住院期间身体功能下降方面具有最强的预测价值。这些结果表明，CONUT 评分可能为预测急性 HF 患者不良结局提供有用信息。
