Prokopidis Konstantinos, Irlik Krzysztof, Hendel Mirela, Piaśnik Julia, Lip Gregory Y H, Nabrdalik Katarzyna
Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2536-2543. doi: 10.1002/jcsm.13596. Epub 2024 Oct 30.
Cachexia, defined as the combination of weight loss, weakness, fatigue, anorexia and abnormal biochemical markers based on Evans' criteria, is known to exacerbate the prognosis of heart failure (HF) patients. This systematic review and meta-analysis investigates the prognostic impact and prevalence of cachexia, as defined by Evans' criteria, in patients with HF.
PubMed, Cochrane Library, Scopus and Web of Science were searched from inception until December 2023, including HF patients for whom the Evans' criteria were applied to explore the prevalence and prognostic impact of cachexia. This study employed a meta-analyses using the random-effects model and inverse-variance method that was adhered to the revised 2020 PRISMA guidelines for systematic reviews and meta-analyses (CRD42023446443).
Six prospective or retrospective studies of 2252 patients with HF were included, whereby all-cause mortality was significantly greater in patients with cachexia with low heterogeneity among studies (HR: 1.60, 95% CI 1.31-1.95, p < 0.001; I = 0%). For the studies that used full, uniformly defined Evans' criteria, among 1844 patients, mortality remained greater in patients with cachexia (HR: 1.58, 95% CI 1.27-1.97, p < 0.001; I = 0%). In a subgroup analysis among 1714 of HF with reduced ejection fraction, the results were consistent (HR: 1.57, 95% CI 1.28-1.92, p < 0.001; I = 0%). Additionally, 10 studies comprising 2862 patients indicated a 31% risk of cachexia in HF (95% CI 21-43%, I = 94%).
Cachexia is an independent predictor for increased all-cause mortality among patients with HF with a notable prevalence of 31%. Interventions aiding in improving fatigue, anorexia and exercise capacity could help improve the quality of life of this clinical population.
恶病质被定义为根据埃文斯标准出现体重减轻、虚弱、疲劳、厌食和异常生化指标的综合情况，已知会使心力衰竭（HF）患者的预后恶化。本系统评价和荟萃分析调查了根据埃文斯标准定义的恶病质在HF患者中的预后影响和患病率。
从创刊至2023年12月检索了PubMed、Cochrane图书馆、Scopus和科学网，纳入应用埃文斯标准的HF患者，以探讨恶病质的患病率和预后影响。本研究采用随机效应模型和逆方差法进行荟萃分析，该方法遵循2020年修订的系统评价和荟萃分析PRISMA指南（CRD42023446443）。
纳入了6项对2252例HF患者的前瞻性或回顾性研究，其中恶病质患者的全因死亡率显著更高，研究间异质性较低（风险比：1.60，95%置信区间1.31 - 1.95，p < 0.001；I² = 0%）。对于使用完整、统一界定的埃文斯标准的研究，在1844例患者中，恶病质患者的死亡率仍然更高（风险比：1.58，95%置信区间1.27 - 1.97，p < 0.001；I² = 0%）。在射血分数降低的HF患者亚组分析中，结果一致（风险比：1.57，95%置信区间1.28 - 1.92，p < 0.001；I² = 0%）。此外，10项包含2862例患者的研究表明HF患者中恶病质风险为31%（95%置信区间21 - 43%，I² = 94%）。
恶病质是HF患者全因死亡率增加的独立预测因素，患病率达31%，颇为显著。有助于改善疲劳、厌食和运动能力的干预措施可能有助于改善这一临床群体的生活质量。
