BackgroundThe Asian Working Group for Cachexia (AWGC) proposed a new definition of cachexia; however, its impact on cachexia prevalence and overlaps with other conditions, such as sarcopenia and malnutrition, are unclear. We investigated these aspects and the prognostic value of cachexia based on the AWGC on mortality in older patients with heart failure (HF).MethodsThis study was a secondary analysis of a prospective multicentre cohort, namely, the FRAGILE‐HF cohort study. Older (≥ 65 years) patients who had been hospitalized due to decompensated HF were enrolled. We assessed the presence/absence of cachexia based on the AWGC and Evans' criteria. Sarcopenia and malnutrition based on the Asian Working Group for Sarcopenia 2014 and the Global Leadership Initiative on Malnutrition criteria were also assessed to compare their prevalence and the overlaps between them. Patients were stratified in relation to the presence/absence of cachexia based on the AWGC criteria, and their mortality rates were compared.ResultsOf the 861 enrolled patients (median [interquartile range] age, 80 years [73–85 years]; male, 58.9%), cachexia, as evaluated based on the AWGC and Evans' criteria, sarcopenia and malnutrition, was present in 74.1%, 36.2%, 20.6% and 55.2% of patients, respectively. AWGC‐defined cachexia was most common in the four conditions. All‐cause death events occurred in 153 (18.1%) patients in 2 years. AWGC‐defined cachexia (adjusted hazard ratio [aHRs], 1.442; 95% confidence interval [95% CI], 0.931–2.233; p = 0.101) was not associated with all‐cause mortality in older patients with HF after adjusting for other HF prognosis factors, such as the B‐type natriuretic peptide and the Meta‐Analysis Global Group in Chronic risk score, whereas cachexia evaluated based on Evans's criteria (aHRs, 1.547; 95% CI, 1.118–2.141; p = 0.009), sarcopenia (aHRs, 1.737; 95% CI, 1.214–2.485; p = 0.003), and malnutrition (aHRs, 1.581; 95% CI, 1.094–2.284; p = 0.015) was associated with all‐cause mortality.ConclusionsThree‐quarters of older patients with HF had cachexia as evaluated by the AWGC criteria, and this was not associated with a worse prognosis. As the new AWGC cachexia criteria will result in a significantly larger proportion of patients being diagnosed with cachexia, the implementation of the criteria in clinical practice requires further consideration.Trial Registration: UMIN‐CTR unique identifier: UMIN000023929

中文翻译：

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新定义诊断的老年心力衰竭患者亚洲人恶病质的患病率和预后价值


背景亚洲恶病质工作组 （AWGC） 提出了恶病质的新定义;然而，它对恶病质患病率的影响以及与其他疾病（如肌肉减少症和营养不良）的重叠尚不清楚。我们研究了这些方面以及基于 AWGC 的恶病质对老年心力衰竭 （HF） 患者死亡率的预后价值。方法本研究是对前瞻性多中心队列的二次分析，即 FRAGILE-HF 队列研究。纳入因失代偿性 HF 住院的老年 （≥ 65 岁） 患者。我们根据 AWGC 和 Evans 标准评估了恶病质的存在/不存在。还根据 2014 年亚洲肌肉减少症工作组和全球营养不良领导倡议标准评估了肌肉减少症和营养不良，以比较它们的患病率和它们之间的重叠。根据 AWGC 标准根据存在/不存在恶病质对患者进行分层，并比较他们的死亡率。结果在 861 名入组患者 （中位 [四分位距] 年龄，80 岁 [73-85 岁];男性，58.9%）中，根据 AWGC 和 Evans 标准评估的恶病质、肌肉减少症和营养不良，分别存在于 74.1% 、 36.2% 、 20.6% 和 55.2% 的患者中。AWGC 定义的恶病质在这四种情况下最常见。2 年内有 153 例 （18.1%） 患者发生全因死亡事件。AWGC 定义的恶病质 （调整后的风险比 [aHRs]，1.442;95% 置信区间 [95% CI]，0.931-2.233;p = 0。101） 在调整了其他 HF 预后因素（如 B 型利钠肽和 Meta 分析慢性风险评分全球组）后，与老年 HF 患者的全因死亡率无关，而根据 Evans 标准评估恶病质 （aHRs， 1.547;95% CI， 1.118–2.141;p = 0.009），肌肉减少症 （aHRs，1.737;95% CI， 1.214–2.485;p = 0.003），营养不良 （aHRs，1.581;95% CI，1.094–2.284;p = 0.015） 与全因死亡率相关。结论根据 AWGC 标准评估，四分之三的老年 HF 患者患有恶病质，这与预后较差无关。由于新的 AWGC 恶病质标准将导致诊断为恶病质的患者比例明显增加，因此在临床实践中实施该标准需要进一步考虑。试验注册：UMIN-CTR 唯一标识符：UMIN000023929