Protein-Energy Malnutrition and Outcomes of Hospitalizations for Heart Failure in the USA
Protein-Energy Malnutrition and Outcomes of Hospitalizations for Heart Failure in the USA
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DOI：
10.1016/j.amjcard.2018.12.014
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发表时间：
2019-03-15
影响因子：
2.8
通讯作者：
Adeboye, Adedayo
中科院分区：
文献类型：
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作者：
Adejumo, Adeyinka Charles;Adejumo, Kelechi Lauretta;Adeboye, Adedayo
心力衰竭（HF）中未减轻的低度炎症导致细胞因子慢性升高，导致蛋白质-能量营养不良（PEM）。然而，尚未在国家数据中评价PEM对因HF急性加重入院的临床结局的影响。从2012年至2014年全国住院患者样本（NIS）患者的主要HF入院出院记录中，我们确定了合并PEM的患者及其人口统计学和共病因素。我们使用基于贪婪算法的方法将PEM队列（32，771）与非PEM对照（1：1）进行倾向匹配，并估计不同临床结局的影响（SAS 9.4）。2012年至2014年，在美国因HF初次入院的541，679例（与2，708，395例相似）中，有32，771例（与163，885例相似）PEM病例。PEM病例年龄较大（PEM：76岁vs无PEM：72岁），白人（70.75% vs 67.30%），合并症负担较高，Deyo合并症指数>3（31.61% vs 26.30%）。然而，PEM病例的肥胖、高脂血症和糖尿病发生率较低。倾向匹配后，PEM与较高的死亡率（AOR：2.48 [2.31 - 2.66]）、心源性休克（3.11[2.79 - 3.46]）、心脏骤停（2.30[1.96 - 2.70]）、急性肾衰竭（1.49[1.44 - 1.54]）、急性呼吸衰竭（1.57[1.51 - 1.64]）、机械通气（2.72[2.50 - 2.97]）相关。PEM还导致更高的非常规出院（2.24 [2.17 - 2.311]）、住院费用（80，534美元[78，496 - 82，625] vs 43，226美元[42，376 - 44，093]）和更长的住院时间（8.6[8.5 - 8.7] vs 5.3[5.2 - 5.3]天）。总之，PEM是住院HF受试者的常见合并症，并导致毁灭性的健康结局。HF受试者在门诊访视期间的PEM早期识别和预防以及在门诊和住院期间的PEM及时治疗对于减少PEM的过度负担至关重要。(C)2019爱思唯尔公司All rights reserved.
Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. From the 2012 to 2014 Nationwide Inpatient Sample (NIS) patient's discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). There were 32,771 (similar to 163,885) cases of PEM among the 541,679 (similar to 2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs no-PEM:72 years), Whites (70.75% vs 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48 [2.31 to 2.66]), cardiogenic shock (3.11[2.79 to 3.46]), cardiac arrest (2.30[1.96 to 2.70]), acute kidney failure (1.49[1.44 to 1.54]), acute respiratory failure (1.57[1.51 to 1.64]), mechanical ventilation (2.72[2.50 to 2.97]). PEM also resulted in higher non-routine discharges (2.24 [2.17 to 2.311), hospital cost ($80,534[78,496 to 82,625] vs $43,226[42,376 to 44,093]) and longer duration of admission (8.6[8.5 to 8.7] vs 5.3[5.2 to 5.3] days). In conclusion, PEM is a prevailing comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in HF subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM. (C) 2019 Elsevier Inc. All rights reserved.