预示急性心肌炎死亡风险的营养指数

Shunichi Doi, Yuki Ishibashi, Norio Suzuki, Daisuke Miyahara, Yukio Sato, Shingo Kuwata, Keisuke Kida, Masaki Izumo, Kenji Onoue, Koshiro Kanaoka, Yoshihiko Saito, Yoshihiro J Akashi
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引用次数: 0

摘要

背景:暴发性心肌炎(FM)是一种急性致命炎症,但其慢性阶段尚不清楚。日本的一项全国性登记使用预后营养指数(PNI)评估了 FM 患者的长期死亡率:这项回顾性队列研究纳入了临床疑似或组织学证实的 FM 患者,并对其进行了 PNI 评估。PNI 在入院和出院时进行评估。我们根据出院时的 PNI 将患者分为两组(PNI ≤40 或 PNI >40),并分析了两组间 PNI 的变化和死亡率。在 323 名患者中(中位数[第一至第三四分位数]年龄为 50 [37-64] 岁,143 [44%] 人为女性),出院时 PNI ≤40 的患者有 99 人(31%)。所有患者的 PNI 中位数从入院时的 41(36-46)升至出院时的 43(39-48)(P<0.0001)。PNI≤40的患者因心血管原因死亡或再次住院的无事件发生率低于PNI>40的患者(对数秩P=0.0001)。在多变量考克斯回归分析中评估出院时的 PNI、年龄、性别、左心室射血分数和 Barthel 指数时,PNI 与心血管原因导致的死亡或再住院有独立关联(危险比,0.95 [95% 置信区间,0.91-0.99];P=0.0289):三分之一出院时 PNI 低的调频患者在慢性期的死亡风险高于 PNI 高的患者。这项研究有助于临床了解 FM 慢性炎症的表型以及低 PNI 患者的最佳随访管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic Nutritional Index in Risk of Mortality Following Fulminant Myocarditis
Background: Fulminant myocarditis (FM) is an acute fatal inflammation disease, but its chronic phase is unclear. A Japanese nationwide registry evaluated the long-term mortality in FM patients using a prognostic nutritional index (PNI). Methods and Results: The retrospective cohort study included patients with clinically suspected or histologically proven FM available for PNI. PNI was assessed on admission and at discharge. We divided patients into two groups based on PNI at discharge (PNI ≤40 or PNI >40) and analyzed the change in PNI and mortality between the groups. Of 323 patients (the median [first-third quartiles] age of this cohort was 50 [37-64] years, and 143 [44%] were female), PNI ≤40 at discharge was in 99 (31%) patients. The median PNI in all patients increased from 41 (36-46) on admission to 43 (39-48) at discharge (P<0.0001). Patients with PNI ≤40 had a lower event-free rate of death or rehospitalization with cardiovascular causes than those with PNI >40 (log-rank P=0.0001). When the PNI at discharge, age, sex, left ventricular ejection fraction, and Barthel index were evaluated in a multivariable Cox regression analysis, the PNI had an independent association with the death or rehospitalization with cardiovascular causes (hazard ratio, 0.95 [95% confidence interval, 0.91-0.99]; P=0.0289). Conclusions: One-third of FM patients with low PNI at discharge had a higher risk of mortality than those with high PNI in the chronic phase. This study provokes clinical insight into the phenotype of chronic inflammation in FM and optimal follow-up management with low PNI.
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