BackgroundCachexia, defined as the combination of weight loss, weakness, fatigue, anorexia and abnormal biochemical markers based on Evans' criteria, is known to exacerbate the prognosis of heart failure (HF) patients. This systematic review and meta‐analysis investigates the prognostic impact and prevalence of cachexia, as defined by Evans' criteria, in patients with HF.MethodsPubMed, Cochrane Library, Scopus and Web of Science were searched from inception until December 2023, including HF patients for whom the Evans' criteria were applied to explore the prevalence and prognostic impact of cachexia. This study employed a meta‐analyses using the random‐effects model and inverse‐variance method that was adhered to the revised 2020 PRISMA guidelines for systematic reviews and meta‐analyses (CRD42023446443).ResultsSix prospective or retrospective studies of 2252 patients with HF were included, whereby all‐cause mortality was significantly greater in patients with cachexia with low heterogeneity among studies (HR: 1.60, 95% CI 1.31–1.95, p < 0.001; I2 = 0%). For the studies that used full, uniformly defined Evans' criteria, among 1844 patients, mortality remained greater in patients with cachexia (HR: 1.58, 95% CI 1.27–1.97, p < 0.001; I2 = 0%). In a subgroup analysis among 1714 of HF with reduced ejection fraction, the results were consistent (HR: 1.57, 95% CI 1.28–1.92, p < 0.001; I2 = 0%). Additionally, 10 studies comprising 2862 patients indicated a 31% risk of cachexia in HF (95% CI 21–43%, I2 = 94%).ConclusionsCachexia is an independent predictor for increased all‐cause mortality among patients with HF with a notable prevalence of 31%. Interventions aiding in improving fatigue, anorexia and exercise capacity could help improve the quality of life of this clinical population.

中文翻译：

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心力衰竭患者的预后影响和恶病质患病率：系统评价和荟萃分析


背景恶病质，定义为根据埃文斯标准体重减轻、虚弱、疲劳、厌食和异常生化标志物的组合，已知会加剧心力衰竭 （HF） 患者的预后。本系统评价和荟萃分析调查了 HF 患者恶病质的预后影响和患病率，如 Evans 标准所定义。方法检索了从建库到 2023 年 12 月的 PubMed、Cochrane Library、Scopus 和 Web of Science，包括应用 Evans 标准以探索恶病质患病率和预后影响的 HF 患者。本研究采用了使用随机效应模型和逆方差方法的荟萃分析，该方法符合修订后的 2020 年 PRISMA 系统评价和荟萃分析指南 （CRD42023446443）。结果纳入了 2252 名 HF 患者的 6 项前瞻性或回顾性研究，其中研究间异质性低的恶病质患者的全因死亡率显著更高（HR：1.60,95% CI 1.31-1.95，p < 0.001;I2 = 0%）。对于使用完整、统一定义的 Evans 标准的研究，在 1844 名患者中，恶病质患者的死亡率仍然更高 （HR： 1.58,95% CI 1.27–1.97，p < 0.001;I2 = 0%）。在 1714 例射血分数降低的 HF 的亚组分析中，结果一致 （HR： 1.57,95% CI 1.28–1.92，p < 0.001;I2 = 0%）。此外，涉及 2862 名患者的 10 项研究表明 HF 有 31% 的恶病质风险 （95% CI 21-43%，I2 = 94%）。结论恶病质是 HF 患者全因死亡率增加的独立预测因子，患病率显著为 31%。 有助于改善疲劳、厌食和运动能力的干预措施可能有助于改善该临床人群的生活质量。