Objectives: To explore the prognostic significances of geriatric nutrition risk index (GNRI), controlling nutritional status (CONUT), and prognostic nutritional index (PNI) in patients with heart failure. Methods: This was a retrospective study. Patients with heart failure admitted to the Department of Cardiology, the first affiliated hospital of Sun Yat-sen University from September 16, 2013 to December 28, 2017 were enrolled. Clinical data of patients were collected and patients were followed up. GNRI, CONUT and PNI scores of patients were calculated. Cox proportional risk model was used to evaluate the relationship between the above three nutritional status scores and the risk of all-cause death in patients with heart failure, and restricted cubic spline analysis was used to verify the relationship. Subgroup analysis was performed based on left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, number of heart failure comorbidities, systolic blood pressure, creatinine, body mass index, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blockers, and use of spironolactone. Results: A total of 2 016 patients with heart failure aged (67.7±13.0) years old were enrolled, including 1 230 (61.0%) males. All patients were followed up until September 15, 2021. Multivariate Cox proportional hazard models showed that increased GNRI score was significantly associated with reduced risk of all-cause mortality in patients with heart failure (HR=0.989, 95%CI 0.982-0.996, P=0.001), while CONUT and PNI scores were not associated with all-cause mortality (both P>0.05). Restricted cubic spline analysis showed no U-shaped relationship between the scores and all-cause death. Subgroup analysis suggested that the prognostic value of GNRI score was predominant in patients not using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (Pinteraction=0.024), while there was no statistically significant difference between groups in other subgroup analyses (Pinteraction>0.05). Conclusions: Increased GNRI score is associated with reduced risk of all-cause mortality in patients with heart failure and may serve as an effective tool to assess nutritional status in patients with heart failure.
目的： 探索三种常用的营养状况评分——老年人营养风险指数（GNRI）、营养控制状态（CONUT）和预后营养指数（PNI）在心力衰竭患者中的预后作用。 方法： 本研究为回顾性研究。纳入2013年9月16日至2017年12月28日在中山大学附属第一医院心内科住院的心力衰竭患者，收集患者临床资料并对患者进行随访。计算患者GNRI、CONUT及PNI评分的分值，采用Cox比例风险模型评价上述3种营养状况评分与心力衰竭患者全因死亡风险的关系，并采用限制性立方样条分析进行验证。根据左心室射血分数、N末端B型利钠肽原、心力衰竭合并症数量、收缩压、肌酐、体重指数、是否使用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂、是否使用β受体阻滞剂、是否使用螺内酯进行亚组分析。 结果： 共纳入2 016例心力衰竭患者，年龄（67.7±13.0）岁，男性1 230例（61.0%）。所有患者随访至2021年9月15日。多因素Cox比例风险模型显示，GNRI评分升高与心力衰竭患者全因死亡风险降低显著相关（HR=0.989，95%CI 0.982~0.996，P=0.001），而CONUT和PNI评分与全因死亡无关（P均>0.05）。限制性立方样条分析显示各评分与全因死亡均不存在U形关系。亚组分析提示GNRI评分在未使用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂的患者中预测全因死亡作用更显著（P交互=0.024），其他亚组分析中组间差异无统计学意义（P交互均>0.05）。 结论： GNRI评分升高与心力衰竭患者全因死亡风险降低相关，可作为临床医生评估心力衰竭患者营养状况的有效工具。.