老年慢性心力衰竭住院患者营养不良风险评估及影响因素分析

Prevalence and Associated Risk Factors of Malnutrition in Hospitalized Older Adults With Chronic Heart Failure

目的:采用客观营养指数评估老年慢性心力衰竭(心衰)住院患者的营养不良风险状况,并分析其影响因素。方法:选取2019年1月1日至2022年12月31日北京大学人民医院心血管内科收治的≥65岁慢性心衰患者260例,采用老年营养风险指数(GNRI)和控制营养状态评分(CONUT)评估患者的营养不良风险,并分析其影响因素。结果:根据GNRI和CONUT评估方法,260例患者中分别有177例(68.1%)和226例(86.9%)患者存在营养不良风险。中或高营养不良风险患者的住院时间延长,血红蛋白含量、估算肾小球滤过率(eGFR)及淋巴细胞计数均低于无营养不良风险及低营养不良风险患者(P均<0.05)。GNRI评估的中或高营养不良风险患者的体重指数以及CONUT评估的中或高营养不良风险患者的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇均低于无营养不良风险及低营养不良风险患者(P均<0.05)。多因素回归分析显示,年龄≥75岁(OR=2.13,95%CI:1.20~3.77,P=0.009)、体重指数≤24.9kg/m^(2)(OR=3.06,95%CI:1.76~5.33,P<0.001)及血红蛋白含量≤121g/L(OR=2.11,95%CI:1.23~3.62,P=0.007)是GNRI评估方法下营养不良风险的危险因素,男性(OR=5.09,95%CI:2.06~11.44,P<0.001)、合并冠心病(OR=2.49,95%CI:1.14~5.44,P=0.023)和血红蛋白含量≤121g/L(OR=3.31,95%CI:1.28~8.59,P=0.014)是CONUT评估方法下营养不良风险的危险因素。结论:老年慢性心衰患者营养不良风险较高,因此应重视营养不良风险的筛查评估,加强对危险因素的认识和干预。

Objectives:To investigate the prevalence and related risk factors of malnutrition at hospitalized older adults(≥65 years)with chronic heart failure.Methods:260 older patients admitted in department of cardiology between January 1,2019 and December 31,2022 were included.Geriatric nutritional risk index(GNRI)and controlling nutritional status score(CONUT)were applied for malnutrition stratification.The correlation between nutritional scores and parameters were explored.Results:The prevalence of malnutrition were 68.1%and 86.9%according to GNRI and CONUT.Patients in moderate-severe malnutrition groups were featured with increased length of stay,lower hemoglobin,eGFR and lymphocyte counts(all P<0.05).Moreover,body mass index based on GNRI and TC,LDL-C and HDL-C based on CONUT were significantly lower in moderately and severely malnourished older patients(all P<0.05).Multivariable analysis showed that age 75 years or older 2(OR=2.13,95%CI:1.20-3.77,P=0.009),BMI≤24.9 kg/m(OR=3.06,95%CI:1.76-5.33,P<0.001)and hemoglobin≤121 g/L(OR=2.11,95%CI:1.23-3.62,P=0.007)were associated with malnutrition by GNRI.Male(OR=5.09,95%CI:2.06-11.44,P<0.001),history of coronary heart disease(OR=2.49,95%CI:1.14-5.44,P=0.023)and lower hemoglobin≤121 g/L(OR=3.31,95%CI:1.28-8.59,P=0.014)were identified as independent risk factors by CONUT.Conclusions:Malnutrition is common in older patients with chronic heart failure.Nutritional screening should be taken into account in risk stratification and management of older heart failure patients.