Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure.
Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure.
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DOI：
10.1161/jaha.116.004876
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发表时间：
2017-06-25
影响因子：
5.4
通讯作者：
Chen CH
中科院分区：
文献类型：
--
作者：
Cheng YL;Sung SH;Cheng HM;Hsu PF;Guo CY;Yu WC;Chen CH
营养状况与心力衰竭患者的临床结果有关。我们评估了以预后营养指数（PNI）为指标的急性心力衰竭住院患者的营养状况与生存率之间的关系。回顾性分析某三级医疗中心收治的急性心力衰竭患者1673例（年龄76±13岁，68%为男性）。PNI计算为10×serum白蛋白(g/dL)+0.005×total淋巴细胞计数（每mm3）。与国家死亡登记处联系，以确定全因死亡和心血管死亡的临床结果。随着PNI分数的增加，年龄和N端脑钠原肽下降，体重指数、肾小球滤过率和血红蛋白增加。在平均31.5个月的随访期间，在总研究人群和左心室射血分数降低或保留的参与者中，较高的PNI分值与更好的无全因生存率和心血管死亡率相关。在考虑了年龄、性别、估计肾小球滤过率、左心室射血分数、血清钠水平和入院时收缩压后，PNI与心血管死亡和总死亡率独立相关（PNI自然对数每1 SD的风险比分别为0.76 [95% CI, 0.66-0.87]和0.79 [95% CI, 0.73-0.87]）。在按年龄、性别、左心室射血分数、体重指数或估计肾小球滤过率分层的亚组分析中，PNI始终与死亡率相关。PNI与左心室射血分数降低或保留的急性心力衰竭住院患者的长期生存率独立相关。
Nutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure. A total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). National Death Registry was linked to identify the clinical outcomes of all‐cause and cardiovascular death. With increasing tertiles of PNI, age and N‐terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow‐up duration of 31.5 months, a higher PNI tertile was related to better survival free from all‐cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on‐admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66–0.87] and 0.79 [95% CI, 0.73–0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality. PNI is independently associated with long‐term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction.