Study On The Diagnostic Value Of NLR Combined With BMI For Decreased Muscle Mass In Elderly Patients With Chronic Heart Failure

Objective:Sarcopenia is more prevalent in elderly patients with chronic heart failure(CHF).Indeed,neutrophil lymphocyte ratio(NLR)and body mass index(BMI)are closely related to muscle mass and strength.However,there are few studies on the relationship between NLR combined with BMI and sarcopenia in elderly patients with CHF.Therefore,this study mainly analyzed the independent risk factors of decreased muscle mass in elderly patients with CHF,and further investigated whether NLR and BMI had diagnostic value for reduced muscle mass in elderly patients with CHF.Methods:1.This is a cross-sectional study.To be specific,a total of 157 patients aged ≥65years who were hospitalized in the geriatric department of Affiliatded Hospital of Qingdao University and Qingdao Eighth People’s Hospital from January 1,2018 to August 1,2021 had been collected.Furthermore,the following clinical data of the patients were collected: 1)Gender,age and BMI;2)Left ventricular ejection fraction(LVEF);3)Inpatient nutritional risk Screening score(NRS2002);4)Serum indicators:white blood cell count,neutrophil count,lymphocyte count,platelet count,hemoglobin(Hb),albumin(ALB),prealbumin(PA),triglyceride(TG),creatinine(Cr),blood urea nitrogen(BUN),N-terminal pro-B-type natriuretic peptide(NT-pro BNP).Apart from that,skeletal muscle mass index(SMI)was measured by Inbody composition analyzer in all patients.2.According to the occurrence of CHF,157 patients were divided into CHF group(n=94)and non-CHF group(n=63).Moreover,the clinical data and the propotion of decreased muscle mass of the two groups were compared.3.NYHA cardiac function was graded in 94 CHF patients.According to the diagnostic criteria set by the Asian Sarcopenia working Group(AWGS)in 2019,they were divided into muscle loss group(n=29)and normal muscle mass group(n=65).In addition,clinical data and cardiac functional state of patients in the two groups were compared.Multifactor Logistic regression was used to analyze the independent risk factors for decreased muscle mass in elderly patients with CHF.Moreover,the diagnostic value of NLR and BMI for loss of muscle mass in elderly patients with CHF was evaluated through receiver operating characteristic(ROC)curve,and the area under curve(AUC)was calculated.Results:1.Comparison between CHF group and non-CHF group:There was no significant difference in age,gender,cell moisture,TG,white blood cell count,neutrophil count,and platelet count between the two groups(P > 0.05).Compared with non-CHF patients,the Cr,BUN,NRS2002,NLR and NT-pro BNP levels in CHF group were higher than those in non-CHF group(P<0.05).Besides,BMI,ALB,PA,lymphocyte count,Hb and LVEF in CHF group were lower than those in non-CHF group(P<0.05).The proportion of decreased muscle mass in CHF group was 30.85%,which was significantly higher than that in non-CHF group(7.94%).Furthermore,the difference was statistically significant(P<0.05).2.Comparison between muscle loss group and normal muscle mass group:The 94 CHF patients were aged from 65 to 95,and the average age was(80.7±8.2)years,including 49 males(52.13%)and 45 females(47.87%).According to the diagnostic criteria of muscle mass loss,there were 29 patients(30.85%)in muscle loss group,including 21 males(72.41%)and 8 females(27.59%).Meanwhile,there were 65 patients(69.15%)in normal muscle mass group,including 28 males(43.08%)and 37 females(56.92%).Compared with normal muscle mass group,the proportion of male patients in muscle loss group was higher than that in normal muscle mass group(P < 0.05).In addition,the age,NRS2002 and NLR in muscle loss group were higher than those in normal muscle mass group,while BMI and lymphocyte count were lower than those in normal muscle mass group(P<0.05).However,cell moisture,ALB,PA,TG,Cr,BUN,white blood cell count,neutrophil count,blood platelet count,HB,LVEF and NT-pro BNP had no statistical significance(P>0.05).According to NYHA cardiac function grading results,in the muscle loss group,8patients(27.59%)were in grade II cardiac function,18 patients(62.07%)were in gradeⅢ cardiac function,and 3 patients(10.34%)were in grade IV cardiac function.In the normal group,40 patients(61.54%)had grade II cardiac function,23 patients(35.38%)had grade Ⅲ cardiac function,and 2 patients(3.08%)had grade IV cardiac function.Namely,the cardiac function status of patients in reduced muscle mass group was worse than that in normal muscle mass group,with statistically significant difference(P<0.05).3.Multivariate Logistic regression analysis of independent risk factors affecting muscle mass in CHF patients:Age,BMI,gender(1=male,2=female),NRS2002,lymphocyte count,NLR and cardiac function grading with statistically significant differences between the muscle loss group and the normal muscle mass group were taken as the independent variables,while decreased muscle mass(0=no,1=yes)was taken as dependent variables and included in multivariate logistic regression analysis.As shown by the results,the BMI(OR=0.764,95%CI:0.600～0.972)and NLR(OR=2.266,95%CI:1.092～4.704)were independent risk factors for muscle loss in elderly CHF patients.4.Correlation analysis of NLR,BMI and cardiac function grading:The correlation analysis of NLR,BMI and heart function grading revealed that there was no statistical correlation between NLR,BMI and heart function grading(r=-0.198,p=0.057;r=0.093,p=0.374).5.Diagnostic value analysis of NLR,BMI and their combination for muscle loss in CHF patients:With NLR and BMI as test variables and muscle loss as status variables,ROC curve analysis indicated that the AUC of NLR was 0.764(95%CI: 0.660-0.868),and the cut-off point of diagnosis was 3.7 by calculating the Yorden index,with sensitivity of 41.4% and specificity of 98.4%.Beyond that,the AUC of BMI was 0.726(95%CI:0.613-0.839),with a sensitivity of 72.4% and specificity of 70.8%.The combined AUC was 0.845(95%CI:0.759-0.932),with a sensitivity of 82.8% and specificity of 81.2%.Conclusion:1.Elderly patients with CHF have a high incidence of decreased muscle mass,and their NLR level is higher,but their BMI is lower than that of non-CHF patients.2.The NLR level of CHF patients in muscle loss group is higher than that in normal muscle mass group,while the BMI is lower and the cardiac function status is worse than that in normal muscle mass group.3.NLR and BMI are independent risk factors for muscle loss in elderly CHF patients,and have diagnostic value for muscle loss in elderly CHF patients respectively.Meanwhile,the combination of the two has a higher diagnostic value.