Appetite loss at discharge from acute decompensated heart failure: Observation from KCHF registry.
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Yamamoto Erika, Kato Takao, Yaku Hidenori, Morimoto Takeshi, Inuzuka Yasutaka, Tamaki Yodo, Ozasa Neiko, Yoshikawa Yusuke, Kitai Takeshi, Taniguchi Ryoji, Iguchi Moritake, Kato Masashi, Takahashi Mamoru, Jinnai Toshikazu, Ikeda Tomoyuki, Nagao Kazuya, Kawai Takafumi, Komasa Akihiro, Nishikawa Ryusuke, Kawase Yuichi, Morinaga Takashi, Kawato Mitsunori, Seko Yuta, Shiba Masayuki, Toyofuku Mamoru, Furukawa Yutaka, Nakagawa Yoshihisa, Ando Kenji, Kadota Kazushige, Shizuta Satoshi, Ono Koh, Sato Yukihito, Kuwahara Koichiro, Kimura Takeshi
Аннотация
METHODS: The Kyoto Congestive Heart Failure registry is a prospective cohort study that enrolled consecutive patients hospitalized for acute decompensated heart failure (ADHF) in Japan. We assessed 3528 patients alive at discharge, and for whom appetite and follow-up data were available. We compared one-year clinical outcomes in patients with and without appetite loss at discharge.
RESULTS: In the multivariable logistic regression analysis using 19 clinical and laboratory factors with P value < 0.1 by univariate analysis, BMI < 22 kg/m2 (odds ratio (OR): 1.57, 95% confidence interval (CI): 1.11-2.24, P = 0.01), CRP >1.0mg/dL (OR: 1.49, 95%CI: 1.04-2.14, P = 0.03), and presence of edema at discharge (OR: 4.30, 95%CI: 2.99-6.22, P<0.001) were associated with an increased risk of appetite loss at discharge, whereas ambulatory status (OR: 0.57, 95%CI: 0.39-0.83, P = 0.004) and the use of ACE-I/ARB (OR: 0.70, 95% CI: 0.50-0.98, P = 0.04) were related to a decreased risk in the presence of appetite loss. The cumulative 1-year incidence of all-cause death (primary outcome measure) was significantly higher in patients with appetite loss than in those without appetite loss (31.0% vs. 15.0%, P<0.001). The excess adjusted risk of appetite loss relative to no appetite loss remained significant for all-cause death (hazard ratio (HR): 1.63, 95%CI: 1.29-2.07, P<0.001).
CONCLUSIONS: Loss of appetite at discharge was associated with worse 1-year mortality in patients with ADHF. Appetite is a simple, reliable, and useful subjective marker for risk stratification of patients with ADHF.