Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195, Japan.
Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195, Japan; Department of Nephrology and Rheumatology, Aichi Medical Center, 17-33 Kawagoe, Nikki-cho, Okazaki, Aichi 444-2148, Japan.
Clin Nutr ESPEN. 2023 Jun;55:167-173. doi: 10.1016/j.clnesp.2023.02.029. Epub 2023 Mar 3.
BACKGROUND & AIMS: Cardiovascular disease (CVD) is a significant cause of mortality and rising healthcare costs, involving numerous chronic and nutritional risk. Although several studies have reported that malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria is associated with mortality in patients with CVD, they have not evaluated this association in terms of malnutrition severity (moderate or severe). Furthermore, the relationship between malnutrition combined with renal dysfunction, a risk factor for death in CVD patients, and mortality has not been previously evaluated. Thus, we aimed to assess the association between malnutrition severity and mortality, as well as malnutrition status stratified by kidney function and mortality, in patients hospitalized due to CVD events.
This single-centre, retrospective cohort study included 621 patients with CVD aged ≥18 years admitted to Aichi Medical University between 2019 and 2020. The relationship between nutritional status based on the GLIM criteria (without malnutrition, moderate malnutrition, or severe malnutrition) and the incidence of all-cause mortality was evaluated by multivariable Cox proportional hazards models.
Patients with moderate and severe malnutrition were significantly more prone to mortality than those without malnutrition (adjusted hazard ratio [HR] of patients without, with moderate, and with severe malnutrition: 1.00 [reference], 1.94 [1.12-3.35], and 2.63 [1.53-4.50], respectively). Furthermore, we found the highest all-cause mortality rate in patients with malnutrition and a lower estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m) (adjusted HR, 10.1; confidence interval, 3.90-26.4) than in patients without malnutrition and normal eGFR (eGFR ≥60 mL/min/1.73 m).
The present study indicated that malnutrition according to the GLIM criteria was associated with increased all-cause mortality in patients with CVD, and malnutrition associated with kidney dysfunction was associated with a higher risk of mortality. These findings provide clinically relevant information to identify high mortality risk in patients with CVD and highlight the need for giving careful attention to malnutrition with kidney dysfunction among patients with CVD.
心血管疾病（CVD）是导致死亡和医疗保健费用增加的主要原因，涉及多种慢性和营养风险。尽管有几项研究报告称，根据全球营养不良倡议（GLIM）标准确定的营养不良与 CVD 患者的死亡率有关，但它们并未评估营养不良严重程度（中度或重度）与死亡率之间的关系。此外，营养不良与肾功能障碍（CVD 患者死亡的危险因素）之间的关系以及营养不良与死亡率之间的关系以前尚未得到评估。因此，我们旨在评估因 CVD 事件住院的患者中，营养不良严重程度与死亡率之间的关系，以及按肾功能和死亡率分层的营养不良状况与死亡率之间的关系。
这是一项单中心、回顾性队列研究，纳入了 2019 年至 2020 年期间在爱知医科大学住院的 621 名年龄≥18 岁的 CVD 患者。使用多变量 Cox 比例风险模型评估基于 GLIM 标准（无营养不良、中度营养不良或重度营养不良）的营养状况与全因死亡率之间的关系。
与无营养不良的患者相比，有中度和重度营养不良的患者更易发生死亡（无营养不良、中度营养不良和重度营养不良患者的调整后危险比[HR]分别为 1.00[参考]、1.94[1.12-3.35]和 2.63[1.53-4.50]）。此外，我们发现营养不良和较低估算肾小球滤过率（eGFR<30 mL/min/1.73 m）（调整后 HR，10.1；95%置信区间，3.90-26.4）的患者的全因死亡率最高，而无营养不良和正常 eGFR（eGFR≥60 mL/min/1.73 m）的患者则较低。
本研究表明，根据 GLIM 标准确定的营养不良与 CVD 患者的全因死亡率增加有关，与肾功能障碍相关的营养不良与更高的死亡率相关。这些发现为识别 CVD 患者的高死亡率风险提供了临床相关信息，并强调需要密切关注 CVD 患者的营养不良和肾功能障碍。
