Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.

To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.

Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.

There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.

On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.

慢性心力衰竭是多种心血管疾病的终末期状态，患者多存在食欲不振、腹泻、腹胀、便秘等营养及代谢问题，营养及代谢问题反过来又影响其预后，目前对于营养评估与慢性心力衰竭患者预后的关系已有一些研究，但关于老年慢性心力衰竭患者营养评估的研究较少，且尚无公认的有效评估方法。

分析影响老年慢性心力衰竭患者预后的营养指标，同时比较其预后评估价值。

选取2018年6月至2020年6月在临沂市人民医院心内科、重症监护室、老年病科住院且符合纳入及排除标准的老年慢性心力衰竭患者199例为研究对象。按照不同预后情况进行分组：按照住院期间是否死亡分为住院死亡组43例与住院存活组156例，按照1年内是否死亡分为1年死亡组51例与1年存活组148例，按照半年内是否再入院分为半年再入院组69例与非半年再入院组130例。通过查阅病历、电话随访，收集患者的性别、年龄、身高、体质量、血清白蛋白（ALB）水平、体质指数（BMI）、老年人营养风险指数（GNRI）、营养风险筛查评分简表（NRS2002）评分。采用多因素Logistic回归分析探讨老年慢性心力衰竭患者预后的影响因素；绘制不同营养评估方法评估老年慢性心力衰竭患者预后的受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC）并比较其评估价值。

住院死亡组与住院存活组年龄、ALB、GNRI、NRS2002评分比较，差异有统计学意义（P<0.05）；1年死亡组与1年存活组年龄、身高、ALB、GNRI、NRS2002评分比较，差异有统计学意义（P<0.05）；半年再入院组与非半年再入院组BMI、ALB、GNRI、NRS2002评分比较，差异有统计学意义（P<0.05）。ALB、NRS2002评分是老年慢性心力衰竭患者住院死亡的影响因素，年龄、ALB、NRS2002评分是患者1年死亡的影响因素，NRS2002评分是患者半年再入院的独立影响因素（P<0.001）。ALB、NRS2002评分评估老年慢性心力衰竭患者住院死亡的AUC分别为0.76〔95%CI（0.68，0.84），P<0.001〕、0.80〔95%CI（0.73，0.86），P<0.001〕；ALB、NRS2002评分评估老年慢性心力衰竭患者1年死亡的AUC分别为0.75〔95%CI（0.67，0.82），P<0.001〕、0.82〔95%CI（0.76，0.88），P<0.001〕；NRS2002评分评估老年慢性心力衰竭患者半年再入院的AUC为0.73〔95%CI（0.65，0.80），P<0.001〕。

NRS2002评分在评估老年慢性心力衰竭患者住院死亡、1年死亡、半年再入院的发生风险时均有统计学意义，可作为老年慢性心力衰竭患者预后评估的首选方法，与BMI、血清ALB水平、GNRI相比更具优越性。