住院老年慢性心功能不全患者营养状态对于短期不良预后的预测价值

Predictive value of nutrition stages for short-time prognosis in hospitalized elderly patients with chronic heart failure

目的利用控制营养状态评分(CONUT)评价住院老年慢性心功能不全患者营养状态对短期不良预后的预测价值。方法本研究共纳入慢性心力衰竭(CHF)患者151例,随访6个月,将随访期间死亡或再次入院患者归为不良预后组(33例),余下患者归为对照组(79例)。所有患者通过CONUT评分评价营养状态。血清N末端B型脑钠肽前体(NT-proBNP)水平和心脏超声评价心功能情况。结果不良预后组患者纽约心脏病协会(NYHA)IV级患者数量多于对照组(54.5%比7.6%,P<0.01)。CONUT评分增高(4.09±1.67 vs 3.22±1.82,P<0.01),其中不良预后组营养正常(0~1分)患者比例低于对照组(6.1%比36.7%,P<0.01),而中度营养不良(5~8分)患者比例高于对照组(45.5%比15.2%,P<0.01)。不良预后组入院时左心室射血分数(LVEF)低于对照组(47.02%±2.66%比48.13%±2.87%,P<0.05),NT-proBNP水平高于对照组[(3864.43±433.84)ng/L比(3631.4±423.56)ng/L,P<0.01]。CONUT评分预测6个月不良预后的cut-off值为5.43,灵敏度82.8%,特异度77.9%。CONUT评分(OR=1.54)和LVEF(OR=1.25)均为老年CHF患者6个月出现不良预后的独立危险因素。结论CONUT评分有助于预测CHF患者短期临床预后。

Objective To assess the predictive value of nutrition stages,using controlling nutritional status(CONUT)score for short-time prognosis in hospitalized elderly patients with chronic heart failure(CHF).Methods One-hundred and fifty-one elderly CHF patients were enrolled in this study and divided into poor prognosis group(n=33)and control group(n=79)based on 6-months follow-up visits.The nutrition stages of patients were evaluated with CONUT.Serum NT-pro BNP level and cardiac ultrasonography were used for cardiac function evaluation.Results The rate of cardiac fundtion stage IV patients in poor prognosis group was higher than that in control group(54.5%vs 7.6%,P<0.01).The CONUT score in poor prognosis group was higher than that in control group(4.09±1.67 vs 3.22±1.82,P<0.01).The levels of LVEF in poor prognosis at admission were lower than those in control group(47.02%±2.66%vs 48.13%±2.87%,P<0.05),while the serum levels of NT-proBNP were higher than those in control group(3864.43±433.84 ng/L vs 3631.4±423.56 ng/L,P<0.01).The cut-off value of CONUT for 6-month poor prognosis was 5.43 with specificity of 77.9%and sensitivity of 82.8%.Both CONUT and LVEF were independent risk factors for 6-month poor prognosis in elderly CHF patients.Conclusion CONUT is a useful tool for nutrition evaluation and may be also a promising predictor for short-time prognosis in elderly CHF patients.