| Objective:The aim of the research is to analyze the relationship between SMI and nutritional status in elderly patients with CHF,and to explore the predictive value of SMI and three objective nutritional indexes alone and in combination for the prognosis of elderly patients with CHF.Methods:A total of 102 elderly patients with CHF who were admitted to the Department of Cardiovascular Medicine,the first hospital of Jilin University from January 2017 to June 2018 and underwent human composition analysis before discharge were selected as CHF group.A total of 125 elderly patients without CHF who underwent human composition analysis hospitalized in the same period and department were selected as control group.Patients in CHF group and control group met the inclusion and exclusion criteria.General condition,auxiliary inspection results,human composition(BMI,FMI,FFMI and SMI)and three kinds of objective nutritional indexes(PNI score,GNRI score and CONUT)were collected.And CHF group was compared with control group in general condition,auxiliary inspection results,human composition and objective nutritional indexes.Patients in CHF group were divided into the SMI severely reduced group and the SMI non-severely reduced group according to Janssen2004 formula.The SMI severely reduced group was compared with the SMI non-severely reduced group in general condition,auxiliary inspection results and objective nutritional indexes.Multiple analysis was used to explore theindependent factor in the severe reduction of SMI.ROC curve was drawn to explore the predictive significance of the independent factor.Patients in CHF group were followed up until December 31,2019,and finally a total of 97 patients were included.According to the presence of cardiovascular endpoint events,they were divided into the event group and the non-event group.The event group was compared with the non-event group in general condition,auxiliary inspection results and human composition.Multiple analysis was used to explore the independent factor in cardiovascular endpoint events.ROC curves were drawn to analyze the predictive value of SMI and three objective nutritional indexes alone and in combination for the prognosis of elderly patients with CHF.Result:1.The proportion of patients with history of diabetes in CHF group was higher than that in control group.BNP,uric acid,urea,serum creatinine,LVEDD and CONUT score in CHF group were higher than those in control group,while total lymphocyte count,hemoglobin,albumin,prealbumin,triglyceride,LVEF,SMI and PNI score were lower than those in control group,with statistically significant difference.There were no significant differences in BMI,FMI and FFMI between two groups.2.Patients in the SMI severely reduced group were older than those in the SMI non-severely reduced group.And total lymphocyte count,LVEF and GNRI score in the SMI severely reduced group were lower than those in the SMI non-severely reduced group,showing statistically significant differences.Multivariate analysis suggested that GNRI score was an independent and protective factor in severe reduction of SMI(OR:0.906,95% confidence interval: 0.852-0.963).ROC curve was used to investigate the value of GNRI score in predicting severe reduction of SMI.The AUC of GNRI score was 0.729.The 95% confidence interval was 0.630 to 0.828 and P<0.0001.GNRI score had predictive value for severe reduction of SMI.3.BNP in the event group was higher than that in the non-event group,and total lymphocyte count and SMI were lower than those in the non-event group with statistically significant difference,while BMI,FMI and FFMI showed no statistically significant difference.Multivariate analysis suggested that SMI was an independent and protective factor in cardiovascular endpoint events(OR: 0.703,95% confidence interval: 0.517 to 0.956).4.ROC curves of SMI and objective nutritional indexes were drawn to predict cardiovascular endpoint events independently and in combination.GNRI score had no predictive significance.Areas under the ROC curves of SMI,PNI score,CONUT score,the combination of SMI and PNI score and the combination of SMI and CONUT score were 0.654,0.639,0.638,0.683 and0.691,respectively.There were no statistically significant differences in the areas under the ROC curves.Conclusion:1.Elderly patients with CHF have lower skeletal muscle mass and poorer nutritional status than control group.2.GNRI score is an independent factor in severe reduction of SMI in elderly patients with CHF,which has predictive significance.Elderly CHF patients with normal nutritional status may also have severe reduction of SMI.3.SMI is an independent factor in cardiovascular endpoint events in elderly patients with CHF.SMI has predictive value for the prognosis of elderly patients with CHF.SMI combining PNI score and SMI combining CONUT score cannot improve the prognostic value of elderly patients with CHF. |
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