Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study
Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study
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DOI：
10.1046/j.1523-1755.1999.00410.x
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发表时间：
1999-05-01
影响因子：
19.6
通讯作者：
Hakim, RM
中科院分区：
文献类型：
--
作者：
Ikizler, TA;Wingard, RL;Hakim, RM
背景大量研究表明，营养与慢性血液透析（CHD）患者的临床结局之间存在密切关系。然而，营养不良和发病率之间的病理生理联系仍有待澄清。此外，最近的证据表明，营养指数可能反映了炎症反应以及蛋白质-热量营养不良。在这项研究中，我们前瞻性地评估了营养状况和炎症反应作为冠心病患者住院决定因素的相对重要性。该研究包括连续测量血清白蛋白，肌酐，转铁蛋白，前白蛋白，C-反应蛋白（CRP）的浓度，电抗值的生物电阻抗分析（BIA）作为一种间接测量瘦体重，每3个月超过15个月的73例冠心病患者。结果由每次数据收集后三个月的住院情况决定。在每个测量集之后的三个月内需要住院的患者与未住院的患者相比，所有参数的值都有显著差异。血清白蛋白（3.93 +/- 0.39 vs. 3.74 +/- 0.39 g/dl），血清肌酐（11.0 +/- 3.7 vs 9.1 +/- 3.5 mg/dl），血清转铁蛋白（181 +/- 35 vs. 170 +/- 34 mg/dl），血清前白蛋白（33.6 +/- 9.2 vs. 30.0 +/- 10.1 mg/dl）和电抗（50.4 +/- 15.6 vs. 43.0 +/- 13.0 ohms）在未住院患者中较高，而CRP（0.78 +/- 0.89 vs. 2.25 +/- 2.72 mg/dl）在未住院患者中较低。所有差异均具有统计学显著性（所有参数P < 0.05）。当进行多变量分析时，血清CRP和电抗值是住院的唯一统计学显著预测因素（两者均P < 0.05）。当血清CRP浓度为0.12 mg/dl被视为参考范围（相对风险1.0）时，CRP浓度为0.92 mg/dl时住院的相对风险高7%（相对风险= 1.07），CRP浓度为3.4 mg/dl时住院的相对风险高30%（相对风险= 1.30）。当电抗值为70欧姆被认为是相对危险度为1.0的参考范围时，电抗值为43欧姆时住院的相对危险度增加到1.09，电抗值为31欧姆时进一步增加到1.14。这项研究的结果强烈表明，营养状况和炎症反应是冠心病患者住院的独立预测因子。CRP和BLA电抗值是住院的可靠指标。内脏蛋白如血清白蛋白、前白蛋白和转铁蛋白在预测住院时受到炎症的影响。当考虑短期临床结果如住院治疗时，应评估炎症和营养标志物。
Background. Numerous studies suggest a strong association between nutrition and clinical outcome in chronic hemodialysis (CHD) patients. Nevertheless, the pathophysiological link between malnutrition and morbidity remains to be clarified. In addition, recent evidence suggests that nutritional indices may reflect an inflammatory response, as well as protein-calorie malnutrition. In this study, we prospectively assessed the relative importance of markers of nutritional status and inflammatory response as determinants of hospitalization in CHD patients.Methods. The study consisted of serial measurements of concentrations of serum albumin, creatinine, transferrin, prealbumin, C-reactive protein (CRP), and reactance values by bioelectrical impedance analysis (BIA) as an indirect measure of lean body mass every 3 months over a period of 15 months in 73 CHD patients. Outcome was determined by hospitalizations over the subsequent three months following each collection of data.Results. Patients who required hospitalization in the three months following each of the measurement sets had significantly different values for all parameters than patients who were not hospitalized. Thus, serum albumin (3.93 +/- 0.39 vs. 3.74 +/- 0.39 g/dl), serum creatinine (11.0 +/- 3.7 vs. 9.1 +/- 3.5 mg/dl), serum transferrin (181 +/- 35 vs. 170 +/- 34 mg/dl), serum prealbumin (33.6 +/- 9.2 vs. 30.0 +/- 10.1 mg/dl), and reactance (50.4 +/- 15.6 vs. 43.0 +/- 13.0 ohms) were higher for patients not hospitalized, whereas CRP (0.78 +/- 0.89 vs. 2.25 +/- 2.72 mg/dl) was lower in patients who were not hospitalized. All differences were statistically significant (P < 0.05 for all parameters). When multivariate analysis was performed, serum CRP and reactance values were the only statistically significant predictors of hospitalization (P < 0.05 for both). When a serum CRP concentration of 0.12 mg/dl was considered as a reference range (relative risk 1.0), the relative risk for hospitalization was 7% higher (relative risk = 1.07) for a CRP concentration of 0.92 mg/dl and was 30% (relative risk = 1.30) higher for a CRP concentration of 3.4 mg/dl. When a reactance value of 70 ohms was considered as a reference range with a relative risk of 1.0, the relative risk of hospitalization increased to 1.09 for a reactance value of 43 ohms and further increased to 1.14 for a reactance value of 31 ohms.Conclusions. The results of this study strongly indicate that both nutritional status and inflammatory response are independent predictors of hospitalization in CHD patients. CRP and reactance values by BLA are reliable indicators of hospitalization. Visceral proteins such as serum albumin, prealbumin, and transferrin are influenced by inflammation when predicting hospitalization. When short-term clinical outcomes such as hospitalizations are considered, markers of both inflammation and nutrition should be evaluated.