心不全入院患者の低栄養と長期予後

心不全入院患者の低栄養と長期予後の関連をみた前向きコホート研究の論文を紹介します。

Bonilla-Palomas JL, et al: Impact of Malnutrition on Long-Term Mortality in Hospitalized Patients With Heart Failure. Rev Esp Cardiol. 2011. doi:10.101/j.recesp.2011.03.009

下記のHPで全文見ることができます。

http://www.revespcardiol.org/sites/default/files/elsevier/eop/S1885-5857(11)00294-5.pdf

心不全で入院した患者208人を対象に、退院前に栄養評価を行い、その後の経過を見ています。栄養評価は主にMNAで行っています。平均年齢73歳、女性46%、心不全の原因で最も多かったのは虚血性心疾患（41%）です。

MNAの結果、13%が低栄養、59.5%が低栄養のリスクあり、栄養状態良好は27.5%でした。中央値25ヶ月間のフォローアップの結果、死亡率はそれぞれ76%、35.9%、18.9%と有意差がありました。多変量解析でも低栄養のハザード比は3.75と有意に高値でした。

低栄養が心不全の独立した予後不良因子であることは今までにも言われてきましたが、約2年間のフォローでこれだけ大きな差が出るということには少し驚きました。また栄養状態良好が27.5%というのは、スペインの論文にしてはかなり低いと感じました。日本で同じ研究をしたら、栄養状態良好の割合はさらに低いと思います。

Introduction and objectives: The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence　and risk of malnutrition as well as its possible influence on long-term mortality in patients with heart　failure.

Methods: A prospective analysis was conducted on 208 patients discharged consecutively from our　centre between January 2007 and March 2008 after being hospitalised with heart failure. Before　discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of　malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with　mortality was assessed by a Cox multivariate analysis.

Results: The mean age of the patients was 73 ± 10 years, with 46% women; the most common aetiology　of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of　malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the　three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P < .001). In the Cox multivariate analysis,　the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P = .001).

Conclusions: Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients.