Prognostic impact of the coexistence of hepato-renal dysfunction and frailty in patients with heart failure
Prognostic impact of the coexistence of hepato-renal dysfunction and frailty in patients with heart failure
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肝肾功能不全与衰弱共存对心力衰竭患者预后的影响
DOI：
10.1016/j.jjcc.2022.08.015
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发表时间：
2023
影响因子：
2.5
通讯作者：
Ako Junya
中科院分区：
文献类型：
--
作者：
Noda Takumi;Kamiya Kentaro;Hamazaki Nobuaki;Nozaki Kohei;Ichikawa Takafumi;Yamashita Masashi;Uchida Shota;Maekawa Emi;Terada Tasuku;Reed Jennifer L.;Yamaoka-Tojo Minako;Matsunaga Atsuhiko;Ako Junya
背景心力衰竭（HF）患者存在复杂的多器官相互作用，如肝肾功能障碍并存，严重影响患者预后。然而，肝/肾功能不全和脆弱性之间的关联和它们共存对HF预后的影响仍不清楚。MethodsThis回顾性队列研究包括922例HF患者（中位年龄，72岁;四分位数间距：62-79岁）。所有患者均使用终末期肝病模型进行肝肾功能检查，不包括国际标准化比率（MELD-XI）评分和虚弱评分。使用四种标记物的复合物测量虚弱：握力、步态速度、血清白蛋白和日常生活状态的活动，组合成总虚弱评分（范围0-12）。患者被分配到虚弱评分<5（无虚弱）或≥5（虚弱）组。采用多因素Logistic回归模型分析MELD-XI评分与虚弱的关系，探讨MELD-XI评分高与虚弱并存的预后价值。在调整协变量并除以MELD-XI评分中位数后，与MELD-XI评分低组相比，MELD-XI评分高组[优势比：1.663，95%可信区间（CI）：1.200- 2.304，p = 0.002]与虚弱显著相关。随访期间发生了150例死亡（中位数，2.13年;四分位距，0.93-4.09年）。即使在调整HF严重程度后，高MELD-XI评分/虚弱组的患者死亡风险也显着更高（风险比：4.326，95% CI：2.527- 7.403，p < 0.001）。结论HF患者肝肾功能不全与虚弱有关，影响患者预后。如通过排除国际标准化比率（MELD-XI）评分的终末期肝病模型所评估的，即使在调整了与HF的虚弱或严重性有关的因素之后，也与虚弱相关。此外，高MELD-XI评分与虚弱相结合与预后较差相关。这些结果表明，肝肾功能不全和虚弱可用于HF患者的危险分层。
BackgroundComplex multi-organ interactions such as coexistence of hepato-renal dysfunction in heart failure (HF) adversely affects patient prognosis. However, the association between liver/kidney dysfunction and frailty and effects of their coexistence on HF prognosis remain unclear.MethodsThis retrospective cohort study included 922 patients with HF (median age, 72 years; interquartile range: 62–79 years). All patients underwent hepato-renal function testing using the model for end-stage liver disease, excluding international normalized ratio (MELD-XI) score and frailty score. Frailty was measured using a composite of four markers: handgrip strength, gait speed, serum albumin, and activities of daily living status, combined into a total frailty score (range 0–12). Patients were assigned to a frailty score <5 (without frailty) or ≥5 (frailty) group. The multivariable logistic regression model was used to analyze the association between MELD-XI score and frailty; the prognostic value of high MELD-XI score and frailty coexistence was investigated. The endpoint was all-cause mortality.ResultsAfter adjusting for covariates and dividing by the median MELD-XI score, the high MELD-XI score group [odds ratio: 1.663, 95 % confidence interval (CI): 1.200–2.304,p= 0.002] was significantly associated with frailty, compared with the low MELD-XI score group. One hundred and fifty deaths occurred during follow-up (median, 2.13 years; interquartile range, 0.93–4.09 years). Patients in the high MELD-XI score/frailty group had a significantly higher mortality risk, even after adjusting for HF severity (hazard ratio: 4.326, 95 % CI: 2.527–7.403,p< 0.001).ConclusionsHepato-renal dysfunction is associated with frailty in patients with HF, which affects patient prognosis.Brief summaryThis study showed that hepato-renal dysfunction in patients with HF, as assessed by the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score, is associated with frailty, even after adjusting for factors involved in the frailty or severity of HF. Additionally, high MELD-XI score combined with frailty is associated with a poorer prognosis. These results suggest that hepato-renal dysfunction and frailty can be used for risk stratification in patients with HF.