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Nomogram model of malnutrition risk in patients suffering from chronic heart failure grounded on GNRI score
Received date: 2024-10-24
Online published: 2025-03-20
Objective We investigated the clinical features and the potential risk factors of malnutrition in patients with chronic heart failure （CHF） ， and constructed the risk prediction model of malnutrition. Methods A total of459 CHF patients admitted between January 2023 and July 2024 were classified into a normal nutrition group and a malnutrition group based on the geriatric Nutrition Risk Index （GNRI） score upon admission. The patient?related data were gathered， and single?variable and multi?variable logistic analyses were first carried out to identify the risk factors associated with the malnutrition risk. Subsequently， the stepwise regression approach was employed to define the inclusion criteria and construct a malnutrition nomogram model for CHF patients. The diagnostic efficacy and calibration of this model were appraised using the ROC curve and calibration curve， and its clinical utility was assessed via the clinical decision curve. A P value less than 0.05 signified statistically significant differences. Results Anxiety （OR = 1.1902，95%CI： 1.0217 ~ 1.3865）， urea nitrogen（OR= 1.4842， 95%CI：1.1187 ~ 1.9691）， low body weight （OR = 0.8463， 95%CI：0.7852 ~ 0.9121）， and low albumin （OR = 0.0467， 95%CI：0.0172 ~ 0.1268） were risk factors for malnutrition. The optimal model inclusion factors were selected by stepwise regression， including： Body weight， 7 items of Generalized Anxiety Disorder Scale （GAD?7）， urea nitrogen， uric acid， albumin， total cholesterol， high density lipoprotein cholesterol （HDL?L）， low density lipoprotein cholesterol （LDL?L）， D?dimer. The area under the ROC curve （AUC） of the column chart model based on the above factors is 0.996 （95%CI： 0.971 ~ 0.978）， with a sensitivity of 97.8% and a specificity of 97.1%. The C?index validated internally in the calibration curve was 0.824. The calibration chart and validation results demonstrate good consistency and applicability. Conclusion The column chart prediction model created in this study based on nine factors including body weight， GAD?7， urea nitrogen， uric acid， albumin， total cholesterol， HDL?L， LDL?L， and D?dimer had good calibration and prediction performance， and had good clinical practicality， which was helpful for clinicians to make diagnosis and treatment decisions for malnutrition in CHF patients.
Key words： chronic heart failure; malnutrition; risk factors; anxiety; nomogram model
Qiaoying MO , Fangyi ZHU , Cunkui ZHU , Shenglong. MA . Nomogram model of malnutrition risk in patients suffering from chronic heart failure grounded on GNRI score[J]. The Journal of Practical Medicine, 2025 , 41(5) : 691 -698 . DOI: 10.3969/j.issn.1006-5725.2025.05.011
| 1 | GRANATA N， TORLASCHI V， ZANATTA F， et al. Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure （CHF） patients undergoing cardiac rehabilitation［J］. Psychol Health Med， 2023， 28（3）： 606-620. doi:10.1080/13548506.2022.2077394 |
| 2 | NGUYEN D D， SPERTUS J A， ALEXANDER K P， et al. Health status and clinical outcomes in older adults with chronic coronary disease： THE ISCHEMIA trial［J］. J Am Coll Cardiol， 2023， 81（17）： 1697-1709. doi:10.1016/j.jacc.2023.02.048 |
| 3 | 国家心血管病中心， 国家心血管病专家委员会心力衰竭专业委员会， 中国医师协会心力衰竭专业委员会， 等. 国家心力衰竭指南2023［J］. 中华心力衰竭和心肌病杂志， 2023， 7（4）： 215-311. |
| 4 | 骆骏骞， 邓志文， 黎土娣， 等. 心力衰竭的治疗进展［J］. 实用医学杂志， 2022， 38（10）： 1181-1186. doi:10.3969/j.issn.1006-5725.2022.10.002 |
| 5 | DRIGGIN E， COHEN L P， GALLAGHER D， et al. Nutrition assessment and dietary interventions in heart failure： JACC review topic of the week［J］. J Am Coll Cardiol， 2022， 79（16）： 1623-1635. doi:10.1016/j.jacc.2022.02.025 |
| 6 | RUSLI C， BUKHARI A， N A T， et al. Nutrition therapy in critically ill overweight elderly patient with heart failure， myocardial infarction， pneumonia， and chronic kidney disease［J］. J Nutr Sci Vitaminol （Tokyo）， 2020， 66： S25-S31. doi:10.3177/jnsv.66.s25 |
| 7 | TSABEDZE N， KINSEY J H， MPANYA D， et al. The prevalence of depression， stress and anxiety symptoms in patients with chronic heart failure［J］. Int J Ment Health Syst， 2021， 15（1）： 44. doi:10.1186/s13033-021-00467-x |
| 8 | 中华医学会心血管病学分会心力衰竭学组， 中国医师协会心力衰竭专业委员会， 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018［J］. 中华心血管病杂志， 2018， 46（10）： 760-789. doi:10.3760/cma.j.issn.0253-3758.2018.10.004 |
| 9 | CHEN Z Q， HAO Q S， SUN R， et al. Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery［J］. CNS Neurosci Ther， 2024， 30（2）： e14343. doi:10.1111/cns.14343 |
| 10 | DAI X Y， YU D J. Analysis of mental health status before and after psychological intervention in response to public health emergencies by medical students： A prospective single-arm clinical trial［J］. Transl Pediatr， 2023， 12（3）： 462-469. doi:10.21037/tp-23-120 |
| 11 | KROENKE K， SPITZER R L， WILLIAMS J B. The PHQ-9： Validity of a brief depression severity measure［J］. J Gen Intern Med， 2001， 16（9）： 606-613. doi:10.1046/j.1525-1497.2001.016009606.x |
| 12 | PHEH K S， TAN C S， LEE K W， et al. Factorial structure， reliability， and construct validity of the Generalized Anxiety Disorder 7-item （GAD-7）： Evidence from Malaysia［J］. PLoS One， 2023， 18（5）： e0285435. doi:10.1371/journal.pone.0285435 |
| 13 | VESKOVIC J， CVETKOVIC M， TAHIROVIC E， et al. Depression， anxiety， and quality of life as predictors of rehospitalization in patients with chronic heart failure［J］. BMC Cardiovasc Disord， 2023， 23（1）： 525. doi:10.1186/s12872-023-03500-8 |
| 14 | BERNARDES S， TEIXEIRA P J Z， SILVA F M. Association of reduced BMI， length of hospital stay， mortality， and malnutrition diagnosis in patients with acute exacerbation COPD： A secondary analysis of a cohort study［J］. JPEN J Parenter Enteral Nutr， 2023， 47（1）： 101-108. doi:10.1002/jpen.2390 |
| 15 | MAO Z， WEN T， LIU X L， et al. Geriatric nutritional risk index is associated with hospital death in elderly patients with multiple organ dysfunction syndrome： A retrospective study based on the MIMIC-III databas［J］. Front Nutr， 2022， 9： 834256. doi:10.3389/fnut.2022.834256 |
| 16 | YENIBERTIZ D， CIRIK M O. The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure［J］. Aging Clin Exp Res， 2021， 33（3）： 611-617. doi:10.1007/s40520-020-01740-8 |
| 17 | PAGNESI M， SERAFINI L， CHIARITO M， et al. Impact of malnutrition in patients with severe heart failure［J］. Eur J Heart Fail， 2024， 26（7）： 1585-1593. doi:10.1002/ejhf.3285 |
| 18 | CZAPLA M， SURMA S， KWASNY A， et al. Association of Body Mass Index with outcomes in patients with heart failure with reduced ejection fraction （HFrEF）［J］. Nutrients， 2024， 16（15）： 2473. doi:10.3390/nu16152473 |
| 19 | YANG X M， LI Q M， GAO Q N. Effect of high-quality nursing intervention on anxiety and depression in patients with chronic heart failure companied malnutrition： A protocol for systematic review and meta-analysis［J］. Medicine （Baltimore）， 2020， 99（22）： e20261. doi:10.1097/md.0000000000020261 |
| 20 | 李雯曦， 刘国顺， 彭程， 等. 老年慢性心衰患者抑郁焦虑状态与血清炎症标志物的相关性［J］. 中华神经医学杂志， 2020， 19（12）： 1228-1234. |
| 21 | 孙媛， 赵黎， 阎艳. 慢性心力衰竭患者焦虑抑郁与营养睡眠质量状况及其相关性分析［J］. 山西医药杂志， 2019， 48（14）： 1697-1699. |
| 22 | SALVIOLI B， PELLEGATTA G， MALACARNE M， et al. Autonomic nervous system dysregulation in irritable bowel syndrome［J］. Neurogastroenterol Motil， 2015， 27（3）： 423-430. doi:10.1111/nmo.12512 |
| 23 | ANDREAE C， STROMBERG A， ARESTEDT K. Prevalence and associated factors for decreased appetite among patients with stable heart failure［J］. J Clin Nurs， 2016， 25（11/12）： 1703-1712. doi:10.1111/jocn.13220 |
| 24 | JOHAL J， HAN C Y， JOSEPH R， et al. Dietary supplements in people with metastatic cancer who are experiencing malnutrition， cachexia， sarcopenia， and frailty： A scoping review［J］. Nutrients， 2022， 14（13）： 2642. doi:10.3390/nu14132642 |
| 25 | ZOU Y F， SONG X J， LIU N， et al. Intestinal flora： A potential new regulator of cardiovascular disease［J］. Aging Dis， 2022， 13（3）： 753-772. doi:10.14336/ad.2021.1022 |
| 26 | 曹选超， 杨新颖， 王心慧， 等. 老年慢性心力衰竭患者情绪障碍与免疫功能的相关性研究［J］. 中国循证心血管医学杂志， 2023， 15（9）： 1085-1088. |
| 27 | 龙珊， 刘兴德， 李甜甜， 等. 冠心病患者经皮冠状动脉介入治疗术后合并焦虑抑郁机制及治疗的研究进展［J］. 实用医学杂志， 2023， 39（21）： 2850-2856. doi:10.3969/j.issn.1006-5725.2023.21.026 |
| 28 | 王小红， 王丽. 不同射血分数心力衰竭患者黄嘌呤氧化酶与尿酸的表达及意义［J］. 实用医学杂志， 2022， 38（10）： 1231-1235. |
| 29 | 郝红梅， 黄海玲， 张微， 等. 慢性心力衰竭患者营养不良风险列线图预测模型的构建与验证［J］. 现代预防医学， 2022， 49（17）： 3130-3135. |
| 30 | JINGI A M， NKOKE C， NOUBIAP J J， et al. Prevalence， correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon［J］. BMC Nephrol， 2022， 23（1）： 8. doi:10.1186/s12882-021-02641-2 |
| 31 | LING S， XU J W. NETosis as a pathogenic factor for heart failure［J］. Oxid Med Cell Longev， 2021， 2021： 6687096. doi:10.1155/2021/6687096 |
| 32 | SZE S， PELLICORI P， KAZMI S， et al. Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure： A comparison with body mass index［J］. JACC Heart Fail， 2018， 6（6）： 476-486. doi:10.1016/j.jchf.2018.02.018 |
| 33 | ESTEBAN-FERNANDEZ A， VILLAR-TAIBO R， ALEJO M， et al. Diagnosis and management of malnutrition in patients with heart failure［J］. J Clin Med， 2023， 12（9）： 3320. doi:10.3390/jcm12093320 |
| 34 | MONGIRDIENE A， LAUKAITIENE J， SKIPSKIS V， et al. Platelet activity and its correlation with inflammation and cell count readings in chronic heart failure patients with reduced ejection fraction［J］. Medicina （Kaunas）， 2021， 57（2）： 176. doi:10.3390/medicina57020176 |
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