Nutritional status in patients with chronic respiratory failure receiving home mechanical ventilation: Impact on survival

作者：Hitzl Andre P; Joerres Rudolf A; Heinemann Frank; Pfeifer Michael; Budweiser Stephan^*

来源：Clinical Nutrition, 2010, 29(1): 65-71.

DOI：10.1016/j.clnu.2009.08.002

• Bioelectrical impedance analysis
• Body composition
• Nutritional depletion
• Prognosis
• Chronic respiratory failure
• Fat-free mass index

Background & aims: In patients with chronic respiratory diseases body mass index (BMI) is a predictor of long-term survival, whereas the prognostic value of body composition, especially fat-free mass index (FFMI), is unknown.
Methods: In a prospectively collected cohort of 131 patients (50 females, 81 mates; 71% chronic obstructive pulmonary disease, 29% severe restrictive disorders) undergoing home mechanical ventilation (HMV) due to chronic hypercapnic respiratory failure (CHRF), the prognostic value of nutritional composition assessed by bioelectrical impedance analysis was evaluated during a 4-year follow-up and compared to that of BMI, anthropometrics, and functional parameters.
Results: After follow-up, 53 patients (40.5%) had died. Regarding all-cause mortality cumulative survival percentages after 1, 2 and 3 years were 89.3, 76.3 and 67.9%, respectively. In univariate analyses, FFMI, BMI, sex, age, leukocyte number, FEV(1) and 6-min walking distance were associated with survival (p < 0.05). Multivariate analyses using the most significant percentiles identified by univariate analysis revealed FFMI (25th percentile; hazard ratio 0.338 [95% confidence interval: 0.189-0.605]), sex, leukocyte number (50th percentile) and FEV(1) (50th percentile) as independent predictors of mortality.
Conclusions: In patients with CHRF and HMV, body composition in terms of FFMI was an independent predictor of long-term survival. FFMI was superior to BMI and seems informative in the multidimensional assessment of these patients.

• 出版日期2010-2