Medstar Georgetown University Hospital Washington DC.
Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD.
J Am Heart Assoc. 2024 Apr 16;13(8):e031616. doi: 10.1161/JAHA.123.031616. Epub 2024 Mar 27.
Frailty is common in heart failure (HF) and is associated with death but not routinely captured clinically. Frailty is linked with inflammation and malnutrition, which can be assessed by a novel plasma multimarker score: the metabolic vulnerability index (MVX). We sought to evaluate the associations between frailty and MVX and their prognostic impact.
In an HF community cohort (2003-2012), we measured frailty as a proportion of deficits present out of 32 physical limitations and comorbidities, MVX by nuclear magnetic resonance spectroscopy, and collected extensive longitudinal clinical data. Patients were categorized by frailty score (≤0.14, >0.14 and ≤0.27, >0.27) and MVX score (≤50, >50 and ≤60, >60 and ≤70, >70). Cox models estimated associations of frailty and MVX with death, adjusted for Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score and NT-proBNP (N-terminal pro-B-type natriuretic peptide). Uno's C-statistic measured the incremental value of MVX beyond frailty and clinical factors. Weibull's accelerated failure time regression assessed whether MVX mediated the association between frailty and death. We studied 985 patients (median age, 77; 48% women). Frailty and MVX were weakly correlated (Spearman's ρ=0.21). The highest frailty group experienced an increased rate of death, independent of MVX, MAGGIC score, and NT-proBNP (hazard ratio, 3.3 [95% CI, 2.5-4.2]). Frailty improved Uno's c-statistic beyond MAGGIC score and NT-proBNP (0.69-0.73). MVX only mediated 3.3% and 4.5% of the association between high and medium frailty groups and death, respectively.
In this HF cohort, frailty and MVX are weakly correlated. Both independently contribute to stratifying the risk of death, suggesting that they capture distinct domains of vulnerability in HF.
衰弱在心力衰竭（HF）中很常见，与死亡相关，但临床上通常无法检测到。衰弱与炎症和营养不良有关，这些可以通过一种新的血浆多标志物评分：代谢脆弱指数（MVX）来评估。我们试图评估衰弱与 MVX 之间的相关性及其预后影响。
在 HF 社区队列（2003-2012 年）中，我们通过磁共振波谱测量了衰弱程度，即 32 项身体限制和合并症中存在缺陷的比例，通过核磁共振光谱测量了 MVX，并收集了广泛的纵向临床数据。患者根据衰弱评分（≤0.14、>0.14 和≤0.27、>0.27）和 MVX 评分（≤50、>50 和≤60、>60 和≤70、>70）进行分类。Cox 模型估计了衰弱和 MVX 与死亡的相关性，调整了 Meta-Analysis Global Group in Chronic Heart Failure（MAGGIC）评分和 NT-proBNP（N 末端 pro-B 型利钠肽）。Uno 的 C 统计量衡量了 MVX 超过衰弱和临床因素的增量价值。Weibull 加速失效时间回归评估了 MVX 是否介导了衰弱与死亡之间的关联。我们研究了 985 名患者（中位年龄 77 岁；48%为女性）。衰弱和 MVX 相关性较弱（Spearman's ρ=0.21）。最高的衰弱组死亡率增加，与 MVX、MAGGIC 评分和 NT-proBNP 无关（危险比，3.3[95%CI，2.5-4.2]）。与 MAGGIC 评分和 NT-proBNP 相比，衰弱提高了 Uno 的 C 统计量（0.69-0.73）。MVX 仅分别介导了高、中衰弱组与死亡之间的 3.3%和 4.5%的关联。
在这个 HF 队列中，衰弱和 MVX 相关性较弱。两者都独立地有助于分层死亡风险，表明它们在 HF 中捕捉到了不同的脆弱性领域。
