Prognostic impact of cachexia by multi-assessment in older adults with heart failure: FRAGILE-HF cohort study

IF 8.9 1区医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-07-11 DOI:10.1002/jcsm.13291

Emi Maekawa, Takumi Noda, Daichi Maeda, Masashi Yamashita, Shota Uchida, Nobuaki Hamazaki, Kohei Nozaki, Hiroshi Saito, Kazuya Saito, Yuki Ogasahara, Masaaki Konishi, Takeshi Kitai, Kentaro Iwata, Kentaro Jujo, Hiroshi Wada, Takatoshi Kasai, Hirofumi Nagamatsu, Tetsuya Ozawa, Katsuya Izawa, Shuhei Yamamoto, Naoki Aizawa, Ryusuke Yonezawa, Kazuhiro Oka, Junya Ako, Shin-ichi Momomura, Nobuyuki Kagiyama, Yuya Matsue, Kentaro Kamiya

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引用次数: 1

Abstract

Background

Cachexia substantially impacts the prognosis of patients with heart failure (HF); however, there is no standard method for cachexia diagnosis. This study aimed to investigate the association of Evans's criteria, consisting of multiple assessments, with the prognosis of HF in older adults.

Methods

This study is a secondary analysis of the data from the FRAGILE-HF study, a prospective multicentre cohort study that enrolled consecutive hospitalized patients aged ≥65 years with HF. Patients were divided into two groups: the cachexia and non-cachexia groups. Cachexia was defined according to Evans's criteria by assessing weight loss, muscle weakness, fatigue, anorexia, a decreased fat-free mass index and an abnormal biochemical profile. The primary outcome was all-cause mortality, as assessed in the survival analysis.

Results

Cachexia was present in 35.5% of the 1306 enrolled patients (median age [inter-quartile range], 81 [74–86] years; 57.0% male); 59.6%, 73.2%, 15.6%, 71.0%, 44.9% and 64.6% had weight loss, decreased muscle strength, a low fat-free mass index, abnormal biochemistry, anorexia and fatigue, respectively. All-cause mortality occurred in 270 patients (21.0%) over 2 years. The cachexia group (hazard ratio [HR], 1.494; 95% confidence interval [CI], 1.173–1.903; P = 0.001) had a higher mortality risk than the non-cachexia group after adjusting for the severity of HF. Cardiovascular and non-cardiovascular deaths occurred in 148 (11.3%) and 122 patients (9.3%), respectively. The adjusted HRs for cachexia in cardiovascular mortality and non-cardiovascular mortality were 1.456 (95% CI, 1.048–2.023; P = 0.025) and 1.561 (95% CI, 1.086–2.243; P = 0.017), respectively. Among the cachexia diagnostic criteria, decreased muscle strength (HR, 1.514; 95% CI, 1.095–2.093; P = 0.012) and low fat-free mass index (HR, 1.424; 95% CI, 1.052–1.926; P = 0.022) were significantly associated with high all-cause mortality, but there was no significant association between weight loss alone (HR, 1.147; 95% CI, 0.895–1.471; P = 0.277) and all-cause mortality.

Conclusions

Cachexia evaluated by multi-assessment was present in one third of older adults with HF and was associated with a worse prognosis. A multimodal assessment of cachexia may be helpful for risk stratification in older patients with HF.

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多重评估对老年心力衰竭患者恶病质预后的影响：FRAGILE-HF队列研究。

背景：恶病质严重影响心力衰竭（HF）患者的预后；然而，目前尚无标准的恶病质诊断方法。本研究旨在调查Evans标准（包括多项评估）与老年人HF预后的关系。方法：本研究是对FRAGILE-HF研究数据的二次分析，FRAGILE-HF研究是一项前瞻性多中心队列研究，纳入了年龄≥65岁的HF连续住院患者。患者分为两组：恶病质组和非恶病质对照组。根据Evans的标准，通过评估体重减轻、肌肉无力、疲劳、厌食、无脂肪质量指数下降和异常生化特征来定义恶病质。主要结果是生存分析中评估的全因死亡率。结果：1306名入选患者中有35.5%存在恶病质（中位年龄[四分位间距]，81[74-86]岁；57.0%为男性）；59.6%、73.2%、15.6%、71.0%、44.9%和64.6%的患者出现体重减轻、肌肉力量下降、无脂肪质量指数低、生物化学异常、厌食和疲劳。2年内270名患者（21.0%）发生全因死亡率。恶病质组（危险比[HR]，1.494；95%置信区间[CI]，1.173-1.903；P=0.001）在校正HF的严重程度后，其死亡率高于非恶病质对照组。心血管和非心血管死亡分别发生在148例（11.3%）和122例（9.3%）患者中。恶病质在心血管死亡率和非心血管死亡率中的校正HR分别为1.456（95%CI，1.048-2.023；P=0.025）和1.561（95%CI：1.086-2.243；P=0.017）。在恶病质诊断标准中，肌肉力量下降（HR，1.514；95%可信区间，1.095-2.093；P=0.012）和低脂肪游离质量指数（HR，1.424；95%置信区间，1.052-1.926；P=0.022）与高全因死亡率显著相关，但单独的体重减轻（HR，1.147；95%CI，0.895-1.471；P=0.0277）与全因死亡率之间没有显著关联。结论：通过多种评估评估的恶病质在三分之一的老年HF患者中存在，并且与更差的预后相关。恶病质的多模式评估可能有助于老年HF患者的风险分层。

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来源期刊

Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine

自引率

12.40%

发文量

期刊介绍： The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.