老年营养风险指数与重症监护室老年心力衰竭患者全因死亡率的关联  

Association of geriatric nutritional risk index with all-cause mortality in elderly patients with heart failure in ICU

作　　者：姬文卿 魏述星 董红锰 陈莹 王茜雅 郭树彬[1] 梅雪[1] JI Wenqing;WEI Shuxing;DONG Hongmeng;CHEN Ying;WANG Xiya;GUO Shubin;MEI Xue(Clinical Research Center of Emergency Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学临床研究中心,北京心肺脑复苏重点实验室,北京100020

出　　处：《临床急诊杂志》2025年第3期162-168,共7页Journal of Clinical Emergency

基　　金：北京市卫生健康委员会首都卫生发展科研专项项目(No:首发2024-2-2034、首发2024-1-1051)。

摘　　要：目的:心力衰竭常合并营养不良,并对预后产生不良影响,本研究旨在探讨老年营养风险指数(geriatric nutritional risk index,GNRI)与重症监护室(intensive care unit,ICU)老年心力衰竭患者短期和长期全因死亡率的关联,为临床管理和干预提供依据。方法:选取MIMIC-Ⅳ数据库中诊断为心力衰竭的老年ICU患者3717例,根据GNRI分级分为4组(无营养风险818例、低营养风险862例、中营养风险1204例、高营养风险833例),结局定义为28 d和1年全因死亡率。使用Kaplan-Meier曲线可视化不同GNRI风险等级对老年心力衰竭患者生存率的影响,采用单因素和多因素Cox回归分析GNRI与死亡率的相关性。采用受试者工作特征曲线下面积、灵敏度及特异度评价GNRI对预后的预测价值,并与序贯器官衰竭评估评分进行比较。结果:无营养风险、低营养风险、中营养风险及高营养风险患者的28 d死亡率分别为8.8%、15.0%、20.8%和36.0%(P<0.001),1年死亡率分别为21.6%、32.7%、46.8%和62.1%(P<0.001)。Kaplan-Meier曲线显示,随着营养风险等级的升高,患者的生存率越低(P<0.001)。多因素Cox回归分析显示,高营养风险患者28 d和1年死亡率的风险比分别为3.63(95%CI 2.79~4.73)和3.37(95%CI 2.83~4.02)。GNRI预测老年心力衰竭患者28 d和1年死亡的曲线下面积分别为0.660和0.666,均高于序贯器官衰竭评估评分(0.648和0.586)。结论:GNRI是ICU中老年心力衰竭患者的独立预测因子,具有一定的预测价值。Objective Heart failure is often accompanied by malnutrition,which adversely affects prognosis.This study aims to explore the association between the geriatric nutritional risk index(GNRI)and short-term and long-term all-cause mortality in elderly intensive care unit(ICU)patients with heart failure,providing a basis for clinical management and intervention.Methods A total of 3717 elderly ICU patients diagnosed with heart failure were selected from the MIMIC-Ⅳdatabase and divided into four groups based on GNRI classification,including 818 cases with no nutritional risk,862 cases with low nutritional risk,1204 cases with moderate nutritional risk and 833 cases with high nutritional risk.Outcomes were defined as 28-day and 1-year all-cause mortality.Kaplan-Meier curves were used to visualize the impact of different GNRI risk levels on the survival rates of elderly heart failure patients.Univariate and multivariate Cox regression analyses were conducted to assess the association between GNRI and mortality.The predictive value of GNRI for prognosis was evaluated using receiver operating characteristic curves,sensitivity,and specificity,and compared with the Sequential Organ Failure Assessment(SOFA)score.Results The 28-day mortality for patients with no nutritional risk,low nutritional risk,moderate nutritional risk and high nutritional risk was 8.8%,15.0%,20.8%and 36.0%(P<0.001),respectively.The 1-year mortality was 21.6%,32.7%,46.8%and 62.1%(P<0.001),respectively.Kaplan-Meier curves showed that as the nutritional risk level increased,the survival rate of patients decreased(P<0.001).The multivariate Cox regression showed that the hazard ratios for 28-day and 1-year mortality in patients with high nutritional risk were 3.63(95%CI 2.79-4.73)and 3.37(95%CI 2.83-4.02),respectively.The area under the curve for GNRI in predicting 28-day and 1-year mortality in elderly heart failure patients was 0.660 and 0.666,both higher than the SOFA scores(0.648 and 0.586).Conclusion GNRI is an independent predictor of mortality in eld

关 键 词：心力衰竭 老年营养风险指数 重症监护室 

分 类 号：R541.6[医药卫生—心血管疾病]