Objective: To evaluate the nutritional status by the Controlling Nutritional Status (CONUT) score and its association with the long-term prognosis in patients with acute heart failure (AHF). Methods: This prospective monocentric study consecutively enrolled patients admitted to our hospital for AHF from April 2012 to May 2016. Patients were divided into 3 groups based on the CONUT score at admission: normal (0-1), mild malnutrition (2-4) and moderate-severe malnutrition (5-12) groups. Baseline information was obtained and recorded within 24 hours after admission. All patients were followed up every 3 months by outpatient visit or telephone call until March 2019. The primary endpoint was all-cause mortality. The Kaplan-Meier survival curves and log-rank test were used to compare all-cause mortality between groups. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality after discharge. Results: A total of 396 patients were enrolled in this study, including 114 patients with normal nutritional status, 200 patients with mild malnutrition and 82 patients with moderate-severe malnutrition. One hundred and fifty-eight patients died during a median follow-up of 34 (18, 46) months. The mortality was 32.4% (37/114), 39% (78/200) and 52.4% (43/82) in normal, mild malnutrition and moderate-severe malnutrition groups, respectively. The mortality was significantly higher in the moderate-severe malnutrition group than in normal nutrition group (P<0.05). However, there was no significant difference in mortality between normal and mild malnutrition group as well as between mild and moderate-severe malnutrition group (both P>0.05). Kaplan-Meier curves indicated that patients with high CONUT score group was at higher risk of all-cause mortality compared with those with low CONUT score (P=0.002). Cox proportional hazard analyses showed that the risk of all-cause mortality of moderate-severe malnutrition group was significantly higher than that of normal nutrition group (HR =1.648, 95%CI 1.021-2.660, P=0.041). Conclusions: The CONUT score of patients with AHF at admission is associated with the long-term prognosis. High CONUT score is an independent risk factor for all-cause mortality in AHF patients after discharge.
目的： 探讨营养控制状态（CONUT）评分与急性心力衰竭（心衰）患者长期预后的相关性。 方法： 该研究为单中心前瞻性队列研究。连续入选2012年4月至2016年5月在南京医科大学第一附属医院心血管内科住院的急性心衰患者，根据入院时的CONUT评分分为3组，正常组（0~1分）、轻度营养不良组（2~4分）和中重度营养不良组（5~12分）。入院24 h内收集入选患者的基线临床资料。出院后每3个月进行1次门诊访视或电话随访，随访至2019年3月。终点事件定义为随访期间发生的全因死亡。采用Kaplan-Meier生存曲线及log-rank检验比较组间全因死亡率。将单因素分析中与全因死亡有关的变量纳入多因素Cox回归模型，分析急性心衰患者出院后全因死亡的独立危险因素。 结果： 研究共纳入患者396例，其中正常组114例（28.8%）、轻度营养不良组200例（50.5%）、中重度营养不良组82例（20.7%）。随访34（18，46）个月，期间共有158例（39.9%）患者发生了终点事件，其中正常组37例（32.4%）、轻度营养不良组78例（39%）、中重度营养不良组43例（52.4%）。三组患者间死亡率差异有统计学意义（P=0.018），其中中重度营养不良组患者的死亡率高于正常组（P<0.05），而正常组与轻度营养不良组、轻度营养不良组与中重度营养不良组组间差异无统计学意义（P均>0.05）。Kaplan-Meier生存曲线分析结果显示CONUT营养不良等级越高患者死亡风险越大（P=0.002）。多因素Cox回归分析结果显示，相对于正常组，中重度营养不良组患者全因死亡风险增加（HR=1.648，95%CI 1.021~2.660，P=0.041）。 结论： 急性心衰患者入院时的CONUT评分与长期预后相关，CONUT评分高是急性心衰患者出院后全因死亡的独立危险因素。.