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           results with prognosis in chronic heart failure has been studied extensively,while nutritional assessment for older adults with
           chronic heart failure has been rarely studied,and there is no clinically recognized assessment method. Objective  To perform
           a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with
           chronic heart failure. Methods Eligible older inpatients with chronic heart failure(n=199) were recruited from Department of
           Cardiology,ICU,and Department of Geriatrics,Linyi People's Hospital from June 2018 to June 2020. Data were collected via
           reviewing the medical records and telephone-based follow-ups,including sex,age,height,weight,serum albumin(ALB)
           level,BMI,Geriatric Nutritional Risk Index(GNRI),and result of Nutrition Risk Screening 2002(NRS2002),as well as
           prognosis〔containing three classifications:in-hospital deaths(n=43) and in-hospital survivors(n=156);one-year deaths
          (n=51) and one-year survivors(n=148);readmission within half a year(n=69) and readmission after half a year(n=130)〕.
           Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC
           curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.
           Results There were significant differences in mean age,serum ALB,GNRI and NRS2002 score between in-hospital deaths
           and survivors(P<0.05). The mean age,height,serum ALB,GNRI and NRS2002 score were also significantly different
           between one-year deaths and survivors(P<0.05). Those with readmission within half a year had significantly different mean
           BMI,serum ALB,GNRI and NRS2002 score compared with those with readmission after half a year(P<0.05). For predicting
           in-hospital death,the AUC of serum ALB was 0.76〔95%CI(0.68,0.84),P<0.001〕,and that of NRS2002 score was
           0.80〔95%CI(0.73,0.86),P<0.001〕. In predicting one-year death,the AUC of serum ALB was 0.75〔95%CI(0.67,
           0.82),P<0.001〕,and that of NRS2002 score was 0.82〔95%CI(0.76,0.88),P<0.001〕. The AUC of NRS2002 score in
           predicting readmission within half a year was 0.73〔95%CI(0.65,0.80),P<0.001〕. Conclusion On the whole,NRS2002
           score could be the first choice for prognostic assessment in elderly patients with chronic heart failure,for it was more effective in
           predicting the risks of in-hospital death,one-year death and readmission within half a year than serum ALB level,GNRI and
           BMI.
               【Key words】 Heart failure;Aged;Nutrition assessment;Body mass index;Serum albumin;GNRI;NRS2002;
           Forecasting;Root cause analysis


               人口老龄化一直是我国的重大社会问题,第七次                           1 对象与方法
           人口普查结果显示 2020 年末全国总人口约为 14.4 亿,                     1.1 研究对象 选取 2018 年 6 月至 2020 年 6 月在临
           其中 60 岁及以上人口占 18.7%,65 岁及以上人口占                      沂市人民医院心内科、重症监护室、老年病科住院且符
           13.5% [1] ,随着老龄化程度进一步加重,我国社会保                       合纳入及排除标准的老年慢性心力衰竭患者 199 例为研
           障和医疗服务压力空前增大。慢性心力衰竭是老年人的                            究对象。纳入标准:(1)心力衰竭的诊断参照《中国
                                                                                           [5]
           常见病,老年慢性心力衰竭患者由于长期处于高能量代                            心力衰竭诊断和治疗指南 2018》 ;(2)年龄≥ 60 岁;
           谢状态,发生营养不良的风险较高,而营养不良同时影                            (3)有详细的实验室检查结果等病历资料。排除标准:
           响着疾病的进展、治疗及预后             [2] 。相关流行病学资料            (1)合并严重肝肾功能不全、肿瘤、血液系统疾病等;(2)
           提示,心力衰竭住院患者中的营养不良患者占比高达                             随访期间发生急性心肌梗死或意外死亡;(3)无法配
           34%~70%,其中有 75%~90% 的重度心力衰竭患者患有                     合评估或无法搜集准确营养状况信息。本研究通过临沂
           营养不良,超过 10%~15% 的患者出现心脏恶病质                 [3] 。    市人民医院伦理委员会批准(批准号:YX200330),
           已有研究证实营养不良是心力衰竭患者预后的独立危险                            获得所有患者知情同意。
           因素,营养不良与重症心力衰竭患者预后关系更为密切,                           1.2 研究方法
           且在住院患者中常见,但不容易被医务人员所发现                     [4] ,    1.2.1 一般资料 通过查阅病历、电话随访收集患者的
           所以寻找及时有效的营养筛查工具显得尤为迫切。老                             性别、年龄、身高、体质量、血清 ALB,并计算 BMI
           年人营养风险指数(GNRI)、营养风险筛查评分简表                           和 GNRI。
                                                                                                           2
                                                                                   2
           (NRS2002)、血清白蛋白(ALB)和体质指数(BMI)                      1.2.2 BMI BMI(kg/m )= 体质量(kg)/ 身高(m ),
                                                                                  2
                                                                                                2
           是临床中常用的 4 种简易营养评估方法,但用于老年慢                          超 重 标 准 为 25 kg/m ≤ BMI<30 kg/m ,肥胖标准为
           性心力衰竭患者的相关营养及预后评估研究鲜见报道。                            BMI ≥ 30 kg/m 2[6] 。
           本研究通过分析、比较 4 种营养评估方法在老年慢性心                          1.2.3 ALB ALB ≤ 35 g/L 为营养不良的诊断标准          [7] 。
           力衰竭患者预后评估中的优劣,旨在探寻一种评估老年                            1.2.4 GNRI GNRI=1.489× 血清 ALB(g/L)+41.7×〔体
           慢性心力衰竭患者预后最敏感的方法以指导临床。                              质量(kg)/ 理想体质量(kg)〕,如果体质量大于理
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