营养控制状态评分与急性心力衰竭患者长期预后的相关性分析

Association between the Controlling Nutritional Status score and long-term outcome in patients with acute heart failure

目的探讨营养控制状态(CONUT)评分与急性心力衰竭(心衰)患者长期预后的相关性。方法该研究为单中心前瞻性队列研究。连续入选2012年4月至2016年5月在南京医科大学第一附属医院心血管内科住院的急性心衰患者,根据入院时的CONUT评分分为3组,正常组(0~1分)、轻度营养不良组(2~4分)和中重度营养不良组(5~12分)。入院24 h内收集入选患者的基线临床资料。出院后每3个月进行1次门诊访视或电话随访,随访至2019年3月。终点事件定义为随访期间发生的全因死亡。采用Kaplan-Meier生存曲线及log-rank检验比较组间全因死亡率。将单因素分析中与全因死亡有关的变量纳入多因素Cox回归模型,分析急性心衰患者出院后全因死亡的独立危险因素。结果研究共纳入患者396例,其中正常组114例(28.8%)、轻度营养不良组200例(50.5%)、中重度营养不良组82例(20.7%)。随访34(18,46)个月,期间共有158例(39.9%)患者发生了终点事件,其中正常组37例(32.4%)、轻度营养不良组78例(39%)、中重度营养不良组43例(52.4%)。三组患者间死亡率差异有统计学意义(P=0.018),其中中重度营养不良组患者的死亡率高于正常组(P<0.05),而正常组与轻度营养不良组、轻度营养不良组与中重度营养不良组组间差异无统计学意义(P均>0.05)。Kaplan-Meier生存曲线分析结果显示CONUT营养不良等级越高患者死亡风险越大(P=0.002)。多因素Cox回归分析结果显示,相对于正常组,中重度营养不良组患者全因死亡风险增加(HR=1.648,95%CI 1.021~2.660,P=0.041)。结论急性心衰患者入院时的CONUT评分与长期预后相关,CONUT评分高是急性心衰患者出院后全因死亡的独立危险因素。

Objective To evaluate the nutritional status by the Controlling Nutritional Status(CONUT)score and its association with the long-term prognosis in patients with acute heart failure(AHF).Methods This prospective monocentric study consecutively enrolled patients admitted to our hospital for AHF from April 2012 to May 2016.Patients were divided into 3 groups based on the CONUT score at admission:normal(0-1),mild malnutrition(2-4)and moderate-severe malnutrition(5-12)groups.Baseline information was obtained and recorded within 24 hours after admission.All patients were followed up every 3 months by outpatient visit or telephone call until March 2019.The primary endpoint was all-cause mortality.The Kaplan-Meier survival curves and log-rank test were used to compare all-cause mortality between groups.Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality after discharge.Results A total of 396 patients were enrolled in this study,including 114 patients with normal nutritional status,200 patients with mild malnutrition and 82 patients with moderate-severe malnutrition.One hundred and fifty-eight patients died during a median follow-up of 34(18,46)months.The mortality was 32.4%(37/114),39%(78/200)and 52.4%(43/82)in normal,mild malnutrition and moderate-severe malnutrition groups,respectively.The mortality was significantly higher in the moderate-severe malnutrition group than in normal nutrition group(P<0.05).However,there was no significant difference in mortality between normal and mild malnutrition group as well as between mild and moderate-severe malnutrition group(both P>0.05).Kaplan-Meier curves indicated that patients with high CONUT score group was at higher risk of all-cause mortality compared with those with low CONUT score(P=0.002).Cox proportional hazard analyses showed that the risk of all-cause mortality of moderate-severe malnutrition group was significantly higher than that of normal nutrition group(HR=1.648,95%CI 1.021-2.660,P=0.041).Conclusions The CONUT score of patients with AHF at admission is associated with the long-term prognosis.High CONUT score is an independent risk factor for all-cause mortality in AHF patients after discharge.