四种不同评分系统评估的老年心力衰竭患者营养不良的患病率及其预后意义。
Prevalence and prognostic importance of malnutrition, as assessed by four different scoring systems, in elder patients with heart failure.
机构信息
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China; Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, No.167 Beilishi Road, 10037, Beijing, China.
出版信息
Nutr Metab Cardiovasc Dis. 2023 May;33(5):978-986. doi: 10.1016/j.numecd.2023.01.004. Epub 2023 Jan 11.
BACKGROUND AND AIMS
The lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems.
METHODS AND RESULTS
Consecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903-1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001).
CONCLUSION
Malnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk.
CLINICAL TRIAL REGISTRATION
URL: ClinicalTrials.gov; Unique Identifier: NCT02664818.
背景与目的
老年心力衰竭（HF）患者缺乏标准的诊断标准，使得营养不良的诊断和管理变得具有挑战性。我们旨在使用四种不同的营养评分系统，探讨老年 HF 患者中营养不良的发生率、相关性及其预后意义。
方法和结果
连续入组年龄 ⩾65 岁、HF 诊断、并入住中国医学科学院阜外医院 HF 病房的患者，评估营养指标。共纳入 1371 例患者（59.4%为男性；平均年龄 72 岁；中位 NT-proBNP 2343ng/L）。使用预后营养指数（PNI）≤38、控制营养状态（CONUT）评分>4、老年营养风险指数（GNRI）≤91、甘油三酯、总胆固醇和体重指数（TCBI）≤1109 评分，分别有 10.4%、18.3%、9.2%和 50.0%的患者存在中重度营养不良。评分越差，体重指数越低，症状越严重，心房颤动和贫血越常见。中位数为 962 天（IQR：903-1029 天）的随访期间，死亡率为 28.3%（n=388）。对于中重度患者，PNI 为 35.2%，CONUT 为 28.3%，GNRI 为 28.0%，TCBI 为 19.1%。在包含了现有预后因素的模型中，任何纳入指标定义的营养不良都显示出了额外的预后价值（C 统计量：0.711）。然而，CONUT 评分定义的营养不良对预后预测价值的改善最为显著（C 统计量：0.721；p<0.001）。
结论
老年 HF 患者中营养不良很常见，并且增加了死亡风险。在所研究的营养评分中，CONUT 评分最能有效预测死亡风险。
临床试验注册
网址：ClinicalTrials.gov；唯一标识符：NCT02664818。
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