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Association between body mass index and prognosis of patients hospitalized with heart failure

Seko, Yuta 京都大学 DOI:10.14989/doctor.k23795

2022.03.23

概要

【背景】
心不全患者において肥満が良好な予後と関連することが報告されているが、低体重と予後の関連の研究は不十分である。今回の研究の目的は、Kyoto Congestive HeartFailure (KCHF) registry のデータを用いて、急性非代償性心不全入院患者における退院時の体格指数 (BMI) の分類と予後との関連を検討することである。

【方法】
KCHF Registry は、日本の19 施設において2014 年10 月から2016 年3 月までの間に入院を要した急性非代償性心不全患者が連続で登録された多施設共同前向き研究である。その中で生存退院した 3509 例を対象に、世界保健機関による BMI 分類を用いて (1) BMI < 16 kg/m2 (238 例)、(2) 16 kg/m2 ≤ BMI < 18.5 kg/m2 (632 例)、(3) 18.5kg/m2 ≤ BMI < 25 kg/m2 (2064 例、普通体重)、(4) 25 kg/m2 ≤ BMI < 30 kg/m2 (448 例)、(5) BMI ≥ 30 kg/m2 (127 例)の5 群に分類し、解析を行った。各BMI 群でのイベントの累積発生率をカプランマイヤー曲線とログランク検定を用いて検討した。さらに、18.5kg/m2 ≤ BMI < 25 kg/m2群をreference として各BMI 群のリスクを比例ハザードモデルを用いて比較した。主要アウトカム評価項目は、全死亡とした。

【結果】
追跡期間中央値は 471 日で、退院後 1 年の追跡率は 96.4％であった。主要アウトカムの1 年での累積発生率は、 BMI < 16 kg/m2群: 36.3%、16 kg/m2 ≤ BMI < 18.5kg/m2群: 23.9%、18.5 kg/m2 ≤ BMI < 25 kg/m2群: 14.4%、25 kg/m2 ≤ BMI < 30 kg/m2群: 7.9%、BMI ≥ 30 kg/m2群: 9.0% (Log-rank P<0.001)であった。主要アウトカムの調整ハザード比は18.5 kg/m2 ≤ BMI < 25 kg/m2群と比較して、BMI < 16 kg/m2群 (HR,2.32; 95% CI, 1.83-2.94; P<0.001)、16 kg/m2 ≤ BMI < 18.5 kg/m2群 (HR, 1.31; 95% CI,1.08-1.59; P=0.005)において有意に高く、25 kg/m2 ≤ BMI < 30 kg/m2群 (HR, 0.82; 95%CI, 0.62-1.10; P=0.18)、BMI ≥ 30 kg/m2群 (HR, 1.09; 95% CI, 0.65-1.85; P=0.74)では有意差は認めなかった。

【結論】
体格指数が低い患者は、普通体重群と比較して全死亡の増加と関連を認め、体格指数が非常に低い患者ではその傾向が大きかった。

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