老年急性心力衰竭患者营养状态与全因死亡的相关性分析

Impact of Nutritional Status on All-cause Death in Elderly Hospitalized Patients With Acute Heart Failure

目的:探讨老年急性心力衰竭患者的营养状态与全因死亡的相关性。方法:前瞻性连续纳入2012年4月至2017年6月因急性心力衰竭于南京医科大学第一附属医院心血管内科住院的老年患者241例。采用老年营养风险指数(geriatric nutritional risk index,GNRI)对患者进行营养评估。按评分标准分为营养正常组(GNRI≥98分)、轻度营养不良组(92分≤GNRI<98分)、中度营养不良组(82分≤GNRI<92分)、重度营养不良组(GNRI<82分)。使用Kaplan-Meier法绘制生存曲线,应用单因素及多因素Cox回归分析分析急性心力衰竭患者的营养状况与全因死亡的关系。结果:241例患者中,营养不良患者占46.9%(113/241),其中轻度营养不良组56例(23.2%),中重度营养不良组(因重度营养不良组患者仅11例,故将中、重度营养不良组合并为一组)57例(23.7%),余128例(53.1%)营养正常者为营养正常组。随访中位时间32(15,45)个月,共109例患者全因死亡。Kaplan-Meier生存曲线发现,中重度营养不良组全因死亡率明显高于轻度营养不良组和营养正常组患者(营养正常组37.5%,轻度营养不良组48.2%,中重度营养不良组59.6%,log-rank P=0.015)。多因素Cox回归提示,中重度营养不良为急性心力衰竭患者全因死亡的独立预测因子(HR=1.68,95%CI:1.07~2.64,P=0.023)。结论:急性心力衰竭患者常合并存在营养不良的状况,中重度营养不良是急性心力衰竭患者死亡的独立危险因素。

Objectives:To investigate the prognostic values of nutritional status in elderly patients hospitalized with acute heart failure(AHF).Methods:Present study prospectively enrolled 241 patients hospitalized with acute heart failure in our department from April 2012 to June 2017.Patients were consecutively followed up to observed the primary endpoint of all-cause mortality.The Geriatric Nutrition Risk Index(GNRI)was used to assess nutrition status of the patients.Kaplan-Meier analysis,univariate and multivariate regression analysis were performed to analyze the relationship between nutritional status and all-cause death in these patients.Results:There were 128(53.1%)patients with normal nutrition,56(23.2%)patients with mild malnutrition and 57(23.7%)patients with moderate to severe malnutrition.A total of 109 patients died of all causes during the 32(15,45)months follow-up.Kaplan-Meier survival curve demonstrated that the all-cause mortality was significantly higher in patients with moderate to severe malnutrition than in patients with mild malnutrition and normal nutrition(normal nutrition group 37.5%,mild malnutrition group 48.2%,moderate to severe malnutrition group 59.6%,log-rank P=0.015).Multivariate Cox regression analysis showed that moderate to severe malnutrition was an independent predictor of all-cause mortality in patients with AHF(hazard ratio[HR]=1.68,95%confidence interval[CI]:1.07-2.64,P=0.023).Conclusions:Malnutrition is a common condition in hospitalized patients with AHF.Moderate to severe malnutrition is an independent risk factor for long term mortality in patients with acute heart failure.