Sato Yoshihiro, Kumada Masahiro, Kawai Hideki, Motoyama Sadako, Sarai Masayoshi, Nakagawa Tsutomu, Izawa Hideo
Department of Cardiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Division of Cardiology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
Fujita Med J. 2023 Aug;9(3):211-217. doi: 10.20407/fmj.2022-028. Epub 2022 Dec 27.
Malnutrition is associated with an increased risk of hospital readmission for heart failure in patients with acute decompensated heart failure (ADHF). Therefore, evaluation of the nutritional status in patients with ADHF may be important. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are widely used objective indexes for evaluation of the nutritional status. The present study was performed to determine the best nutritional index for predicting the prognosis in older adults with ADHF.
We retrospectively studied 167 older adults (>65 years of age) who were admitted with ADHF from January 2012 to December 2015 and discharged alive. The objective nutritional status was evaluated using the GNRI, CONUT score, and PNI at admission. The endpoint of this study was unplanned hospitalization for worsening heart failure (WHF) within 1 year after discharge.
During the follow-up period, 58 patients were readmitted for WHF. In the multivariate Cox analysis, only the GNRI (<0.0001) was independently associated with readmission for WHF among the three nutritional indexes. Kaplan-Meier analysis revealed that patients in the low-GNRI group (<90 as determined by receiver operating characteristic curve analysis) had a significantly greater risk of 1-year hospital readmission for WHF (<0.0001; hazard ratio, 6.1; 95% confidence interval, 3.5-10.5).
Among the objective nutritional indexes, the GNRI is the best predictor of readmission for WHF within 1 year after discharge in older adults with ADHF.
营养不良与急性失代偿性心力衰竭（ADHF）患者因心力衰竭再次入院的风险增加相关。因此，评估ADHF患者的营养状况可能很重要。老年营养风险指数（GNRI）、控制营养状况（CONUT）评分和预后营养指数（PNI）是广泛用于评估营养状况的客观指标。本研究旨在确定预测老年ADHF患者预后的最佳营养指标。
我们回顾性研究了2012年1月至2015年12月因ADHF入院且存活出院的167名老年人（>65岁）。入院时使用GNRI、CONUT评分和PNI评估客观营养状况。本研究的终点是出院后1年内因心力衰竭恶化（WHF）而计划外住院。
在随访期间，58名患者因WHF再次入院。在多变量Cox分析中，在三个营养指标中，只有GNRI（<0.0001）与因WHF再次入院独立相关。Kaplan-Meier分析显示，低GNRI组（根据受试者工作特征曲线分析确定<90）的患者因WHF 1年内再次入院的风险显著更高（<0.0001；风险比，6.1；95%置信区间，3.5-10.5）。
在客观营养指标中，GNRI是老年ADHF患者出院后1年内因WHF再次入院的最佳预测指标。
