Zhou Ting, Luo Songyuan, Lin Wenhui, Sun Yinghao, Wang Jizhong, Liu Jitao, Liu Yuan, Huang Wenhui, Yang Fan, Li Jie, Luo Jianfang
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510515 Guangzhou, Guangdong, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510515 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2024 Jul 5;25(7):249. doi: 10.31083/j.rcm2507249. eCollection 2024 Jul.
Malnutrition is a poor prognostic factor in a wide range of diseases. Nevertheless, there is a lack of data investigating the association between malnutrition and outcomes of patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Therefore, the aim of the present study was to report the prevalence and clinical impact of malnutrition assessed by the controlling nutritional status (CONUT) score in TBAD patients undergoing TEVAR.
The retrospective study indicated that a total of 881 patients diagnosed with TBAD and treated with TEVAR from January 2010 to December 2017 were categorized into subgroups based on their CONUT score (low 5 . high 5). To assess the correlation between malnutrition and early and follow-up outcomes of TBAD patients, logistic and Cox regression analysis were utilized, incorporating inverse probability weighting.
Malnutrition was present in 20.3% of patients according to the CONUT score. Multivariate logistic regression analysis revealed that pre-operative CONUT score modeled as a continuous variable was an independent risk factor for prolonged intensive care unit stay (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.17; = 0.015), 30-day death (OR, 1.43; 95% CI, 1.19-1.72; 0.001), delirium (OR, 1.11; 95% CI, 1.01-1.23; = 0.035) and acute kidney injury (OR, 1.09; 95% CI, 1.01-1.16; = 0.027). During a median follow-up of 70.8 (46.1-90.8) months, 102 (11.8%) patients died (high CONUT group: 21.8% . low CONUT group: 9.0%; 0.001). Multivariable Cox proportional-hazards models showed that malnutrition was an independent predictor for follow-up mortality (hazard ratio, 1.68; 95% CI, 1.11-2.53; = 0.014). Results remained consistent across various sensitivity analyses.
Malnutrition assessed by the CONUT score could profoundly affect the early and follow-up prognosis in patients undergoing TEVAR. Routine pre-intervention nutritional evaluation might provide valuable prognostic information.
营养不良是多种疾病预后不良的因素。然而，目前缺乏关于营养不良与接受胸主动脉腔内修复术（TEVAR）的B型主动脉夹层（TBAD）患者预后之间关系的数据。因此，本研究旨在报告通过控制营养状况（CONUT）评分评估的营养不良在接受TEVAR的TBAD患者中的患病率及其临床影响。
这项回顾性研究表明，2010年1月至2017年12月期间共881例诊断为TBAD并接受TEVAR治疗的患者根据其CONUT评分（低≤5，高＞5）被分为亚组。为了评估营养不良与TBAD患者早期及随访结果之间的相关性，采用了逻辑回归和Cox回归分析，并纳入了逆概率加权法。
根据CONUT评分，20.3%的患者存在营养不良。多变量逻辑回归分析显示，术前CONUT评分作为连续变量是重症监护病房住院时间延长（比值比[OR]，1.09；95%置信区间[CI]，1.02-1.17；P = 0.015）、30天死亡（OR，1.43；95% CI，1.19-1.72；P＜0.001）、谵妄（OR，1.11；95% CI，1.01-1.23；P = 0.035）和急性肾损伤（OR，1.09；95% CI，1.01-1.16；P = 0.027）的独立危险因素。在中位随访70.8（46.1-90.8）个月期间，102例（11.8%）患者死亡（高CONUT组：21.8%，低CONUT组：9.0%；P＜0.001）。多变量Cox比例风险模型显示，营养不良是随访死亡率的独立预测因素（风险比，1.68；95% CI，1.11-2.53；P = 0.014）。在各种敏感性分析中结果均保持一致。
通过CONUT评分评估的营养不良会深刻影响接受TEVAR患者的早期及随访预后。术前常规营养评估可能会提供有价值的预后信息。
