Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients
Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients
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DOI：
10.1016/j.healun.2015.05.027
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发表时间：
2015-11-01
影响因子：
8.9
通讯作者：
Hummel, Scott L.
中科院分区：
文献类型：
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作者：
Adejumo, Oluwayemisi L.;Koelling, Todd M.;Hummel, Scott L.
背景：住院的晚期心力衰竭（HF）患者营养不良和死亡的风险较高。营养风险指数（NRI）是一种简单且经过充分验证的工具，用于识别有营养相关并发症风险的患者。我们假设，在来自ESCAPE（充血性心力衰竭和肺动脉导管插入术有效性评估研究）试验的晚期HF患者中，NRI将提高对6个月全因死亡率的风险判别能力。
方法：我们分析了160名有完整随访和NRI数据的ESCAPE入选幸存者，NRI计算如下：NRI =（1.519×出院时血清白蛋白[单位：g/dl]）+（41.7×出院时体重[单位：kg]/理想体重[单位：kg]）；如先前研究，如果出院时体重大于理想体重（IBW），该比值设为1。先前建立的ESCAPE死亡率模型包括：年龄；6分钟步行距离；心肺复苏/机械通气；出院时β受体阻滞剂处方和利尿剂剂量；以及出院时血清钠、血尿素氮和脑钠肽水平。我们使用Cox比例风险模型分析6个月全因死亡率这一结果。
结果：160名患者中有30名在出院后6个月内死亡。NRI中位数为96（四分位间距91 - 102），反映出轻度至中度营养风险。NRI独立预测6个月死亡率，每10个单位调整后的风险比（HR）为0.60（95%置信区间0.39 - 0.93，p = 0.02），加入ESCAPE模型后，Harrell's c指数从0.74提高到0.76。入院时的体重指数和NRI并不能预测6个月死亡率。出院时的NRI对ESCAPE模型预测死亡率高（>20%）的患者最有帮助，在这些患者中，NRI < 100的患者6个月观察到的死亡率为38%，而NRI > 100的患者为14%（p = 0.04）。
结论：NRI是一种简单的工具，可改善住院的晚期HF患者出院时的死亡风险分层。由爱思唯尔公司出版。
BACKGROUND: Hospitalized advanced heart failure (HF) patients are at high risk for malnutrition and death. The Nutritional Risk Index (NRI) is a simple, well-validated tool for identifying patients at risk for nutrition-related complications. We hypothesized that, in advanced HF patients from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, the NRI would improve risk discrimination for 6-month all-cause mortality.METHODS: We analyzed the 160 ESCAPE index admission survivors with complete follow-up and NRI data, calculated as follows: NRI = (1.519 x discharge serum albumin [in g/d11) -I- (41.7 x discharge weight [in kg] / ideal body weight [in kg]); as in previous studies, if discharge weight is greater than ideal body weight (IBW), this ratio was set to I. The previously developed ESCAPE mortality model includes: age; 6-minute walk distance; cardiopulmonary resuscitation/mechanical ventilation; discharge beta-blocker prescription and diuretic dose; and discharge serum sodium, blood urea nitrogen and brain natriuretic peptide levels. We used Cox proportional hazards modeling for the outcome of 6-month.allcause mortality.RESULTS: Thirty of 160 patients died within 6 months of hospital discharge. The median NRI was 96 (IQR 91 to 102), reflecting mild-to-moderate nutritional risk. The NR1 independently predicted 6-month mortality, with adjusted HR 0.60 (95% CI 0.39 to 0.93, p = 0.02) per 10 units, and increased Harrell's c-index from 0.74 to 0.76 when added to the ESCAPE model. Body mass index and NRI at hospital admission dichnot predict 6-month mortality. The discharge NRI was most helpful in patients with high ( > 20%) predicted mortality by the ESCAPE model, where observed 6-month mortality was 38% in patients with NRI < 100 and 14% in those with NRI > 100 (p = 0.04).CONCLUSIONS: The NRI is a simple,tool that can improve mortality risk stratification at hospital discharge in hospitalized patients with advanced HF. Published by Elsevier Inc.