Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients
Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients
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DOI：
10.1093/ajcn/80.2.299
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发表时间：
2004-08-01
影响因子：
7.1
通讯作者：
Kopple, JD
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh, K;Block, G;Kopple, JD
背景：营养不良-炎症复合综合征是维持性血液透析（MHD）患者的预后预测因子，可能与厌食症有关。目的：我们研究了主观报告的食欲是否与MHD患者的不良状况和发病率和死亡率增加有关。设计：一组331名MHD门诊患者被要求对他们最近的食欲状况进行评分，从1到4（非常好，好，一般，食欲差）。分别)。测定贫血指标及营养和炎症指标，包括血清c反应蛋白、肿瘤坏死因子a、白细胞介素6的浓度。采用营养不良-炎症评分法评估营养不良-炎症复合综合征，采用SF36问卷评估生活质量（QoL）。结果：患者年龄为54.5±14.4岁。124例（38%）患者报告食欲下降（从一般到较差）。血红蛋白、蛋白质摄入量和生活质量评分逐渐降低，而炎症标志物、营养不良炎症评分和所需的促红细胞生成素剂量在食欲恶化类别中较高。血清肿瘤坏死因子a和c反应蛋白浓度升高导致食欲减少与正常的校正比值比显著。观察到食欲不良与住院率和死亡率增加之间存在显著关联。食欲减退导致的死亡风险比为4.74 （95% CI: 1.85, 12.16; P = 0.001）。结论：食欲减退（厌食症）与促炎细胞因子浓度升高、促红细胞生成素水平升高、反应性低下和临床预后差相关，包括MHD患者死亡率增加4倍、住院率增加和生活质量差。食欲状况可能对透析患者的临床状况有重要意义。
Background: Mal nutrition-inflammation complex syndrome, an outcome predictor in maintenance hemodialysis (MHD) patients, may be related to anorexia.Objectives: We examined whether subjectively reported appetite is associated with adverse conditions and increased morbidity and mortality in MHD patients.Design: A cohort of 331 MHD outpatients was asked to rate their recent appetite status on a scale from I to 4 (very good, good, fair, and poor appetite. respectively). Anemia indexes and nutritional and inflammatory markers-including serum concentrations of C-reactive protein, tumor necrosis factor a, and interleukin 6-were measured. The malnutrition-inflammation score was used to evaluate the malnutrition-inflammation complex syndrome, and the SF36 questionnaire was used to assess quality of life (QoL). Mortality and hospitalization were followed prospectively for up to 12 mo.Results: Patients were aged 54.5 +/- 14.4 y. Diminished appetite (fair to poor) was reported by 124 patients (38%). Hemoglobin, protein intake, and QoL scores were progressively lower, whereas markers of inflammation, malnutrition-inflammation scores, and the required erythropoietin dose were higher across the worsening categories of appetite. The adjusted odds ratios of diminished versus normal appetite for increased serum tumor necrosis factor a and C-reactive protein concentrations were significant. Significant associations between a poor appetite and an increased rate of hospitalization and mortality were observed. The hazard ratio of death for diminished appetite was 4.74 (95% CI: 1.85, 12.16; P = 0.001).Conclusion: Diminished appetite (anorexia) is associated with higher concentrations of proinflammatory cytokines and higher levels of erythropoietin hyporesponsiveness and poor clinical outcome, including a 4-fold increase in mortality, greater hospitalization rates, and a poor QoL in MHD patients. Appetite status may yield significant insight into the clinical status of dialysis patients.