术前营养状况对心脏移植患者的预后意义。

Prognostic significance of preoperative nutritional status for heart transplantation patients.

机构信息

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

出版信息

BMC Cardiovasc Disord. 2024 Oct 16;24(1):563. doi: 10.1186/s12872-024-04231-0.

DOI:10.1186/s12872-024-04231-0

PMID:39407105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11481773/

Abstract

BACKGROUND

The association between malnutrition and outcomes of heart transplantation (HTx) has not been well studied. The purpose of this article was to evaluate the prognostic value of three different nutrition indices in HTx, including CONUT (Controlling Nutritional Status), NRI (Nutritional Risk Index) and GNRI (Geriatric Nutritional Risk Index).

METHODS

A total of 438 patients who underwent THx from January 2015 to December 2020 were included in this study. The nutritional status of the patients was evaluated by CONUT, NRI and GNRI. Kaplan-Meier (KM) curves were constructed to compare the difference in overall survival (OS) between the normal and malnutrition groups in each index. Cox regression analysis was used to identify the independent risk factors of OS. The predictive power was compared by time-dependent ROC and time-dependent ccurves. Logistic regression model was used to evaluate the relationship between these three nutrition indices and postoperative clinical events.

RESULTS

336 (76.7%), 183 (43.8%), and 190 (43.4%) patients had malnutrition according to CONUT, NRI and GNRI calculations. 102 (23.3%) patients had died at the end of follow-up. After adjustment for confounding variables, multivariate Cox analysis showed that CONUT [HR 1.286 (95%CI 1.166 ~ 1.419); p < 0.001], NRI [HR 0.942 (95%CI 0.923 ~ 0.962); p < 0.001] and GNRI [HR 0.959 (95%CI 0.939 ~ 0.979); p < 0.001] were all independent predictors for OS. The predictive power of CONUT score was higher than that of NRI (p = 0.045) and GNRI (p < 0.001). Regarding the postoperative complications, multivariate logistic regression model showed that malnutrition assessed by CONUT [HR 1.156 (95%CI 1.032 ~ 1.294); p = 0.012] and NRI [HR 1.543 (95%CI 1.008 ~ 2.362); p = 0.046] was independent risk factors for posttransplant infections.

CONCLUSION

Poor nutritional status, as assessed by CONUT, NRI and GNRI, was associated with an increased risk of mortality after HTx. CONUT displayed the highest predictive power compared to the other two indices. CONUT and NRI were also independently associated with posttransplant infections.

摘要

背景

营养不良与心脏移植（HTx）的结果之间的关联尚未得到很好的研究。本文旨在评估三种不同营养指数在 HTx 中的预后价值，包括 CONUT（控制营养状况）、NRI（营养风险指数）和 GNRI（老年营养风险指数）。

方法

本研究共纳入 2015 年 1 月至 2020 年 12 月期间接受 THx 的 438 例患者。通过 CONUT、NRI 和 GNRI 评估患者的营养状况。绘制 Kaplan-Meier（KM）曲线，比较每个指数中正常组和营养不良组之间的总生存（OS）差异。Cox 回归分析用于确定 OS 的独立危险因素。通过时间依赖性 ROC 和时间依赖性曲线比较预测能力。使用逻辑回归模型评估这三种营养指数与术后临床事件的关系。

结果

根据 CONUT、NRI 和 GNRI 计算，336 例（76.7%）、183 例（43.8%）和 190 例（43.4%）患者存在营养不良。随访结束时，102 例（23.3%）患者死亡。调整混杂因素后，多变量 Cox 分析显示 CONUT[HR 1.286（95%CI 1.166~~1.419）；p<0.001]、NRI[HR 0.942（95%CI 0.923~~0.962）；p<0.001]和 GNRI[HR 0.959（95%CI 0.9390.979）；p<0.001]均为 OS 的独立预测因子。CONUT 评分的预测能力高于 NRI（p=0.045）和 GNRI（p<0.001）。关于术后并发症，多变量逻辑回归模型显示，CONUT 评估的营养不良[HR 1.156（95%CI 1.0321.294）；p=0.012]和 NRI[HR 1.543（95%CI 1.008~2.362）；p=0.046]是移植后感染的独立危险因素。