骨骼肌质量和过度水合与急性心力衰竭患者的住院死亡率有关

摘要(中文译文)

本研究旨在确定急性心力衰竭患者低肌肉质量及异常液体分布与院内死亡率之间的关联。在这项于墨西哥城Salvador Zubiran国家医学科学与营养研究所开展的前瞻性队列研究中，纳入了2017年9月至2024年7月期间因急性心力衰竭入院且在入院前后72小时内接受胸部或腹部计算机断层扫描的患者。排除标准为计算机断层扫描图像无法判读、生物阻抗分析读数不正确、存在癌症、COVID-19、接受肾脏替代治疗的慢性肾脏病，或急性心力衰竭诊断被排除。在住院最初24小时内进行生物电阻抗分析，测量相位角和阻抗比以评估水合状态。骨骼肌面积通过单个轴位层面测量，腹部计算机断层扫描取L3水平，胸部计算机断层扫描取T4水平。本研究共纳入134例患者，总体院内生存率为83.6%。死亡组的腹部骨骼肌面积较低（86.5 vs. 111 cm²，p=0.024），胸肌骨骼肌面积较小（18.9 vs. 26 cm²，p=0.005），相位角较低（3 vs. 3.9，p=0.010），阻抗比升高（0.89 vs. 0.86，p=0.002），胸肌质量减少的患病率更高（40.9 vs. 12.5%，p<0.001），且根据阻抗比判断的异常液体分布比例更高（86.4 vs. 57.1%，p=0.016）。在生存分析中，胸肌骨骼肌面积与阻抗比升高的交互效应具有最低的生存概率（log-rank检验，p<0.001）。低骨骼肌质量与异常液体分布与急性心力衰竭患者的院内死亡率相关。

Abstract

The aim of the study was to determine the association between low muscle mass and abnormal fluid distribution with in-hospital mortality in patients with acute heart failure. In a prospective cohort study at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran in Mexico City, patients with acute heart failure who underwent thoracic or abdominal computed tomography within 72 h before or after admission between September 2017 and July 2024 were included. The exclusion criteria were an illegible computed tomography scan, an incorrect bioimpedance analysis lecture, the presence of cancer, COVID-19, chronic kidney disease with renal replacement therapy, or dismissal of a diagnosis of acute heart failure. Bioelectrical impedance analysis was performed within the first 24 h of hospitalization to measure phase angle and impedance ratio for evaluating hydration status. The skeletal muscle area was measured using a single axial slide at L3 for abdominal computed tomography and the T4 level for thoracic computed tomography. This study included 134 patients, with an overall hospital survival rate of 83.6%. The mortality group had a lower abdominal skeletal muscle area (86.5 vs. 111 cm2, p=0.024), smaller pectoral skeletal muscle area (18.9 vs. 26 cm2, p=0.005), lower phase angle (3 vs. 3.9, p=0.010), increased impedance ratio (0.89 vs. 0.86, p=0.002), greater prevalence of reduced pectoral muscle mass (40.9 vs. 12.5%, p<0.001), and abnormal fluid distribution according to impedance ratio (86.4 vs. 57.1%, p=0.016). In survival analyses, the interaction effect of pectoral skeletal muscle area and increased impedance ratio had the lowest survival probability (log-rank test, p<0.001). Low skeletal muscle mass and abnormal fluid distribution are associated with in-hospital mortality in patients with acute heart failure.

如何引用

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