​Vpliv žeje in apetita na klinične izide pri bolnikih s srčnim popuščanjem

Plesec, Špela (avtor), Farkaš Lainščak, Jerneja (mentor), Kvas, Andreja (komentor)

Uvod: Žeja in izguba apetita sta pogosta, a velikokrat prezrta simptoma pri bolnikih s srčnim popuščanjem (SP). Namen: Ugotoviti spremembe v dimenzijah žeje in apetita, njihovo povezanost s socialno-demorafskimi in kliničnimi dejavniki ter morebitne vplive na klinične izide. Metode: Izvedli smo psihometrično evalvacijo, presečno pregledno epidemiološko raziskavo in prospektivni opazovalni raziskavi. Zbirali smo podatke o socialno-demografskih in kliničnih značilnostih, dimenzijah žeje in apetita, anksioznosti in depresiji, z zdravjem povezani kakovosti življenja ter kliničnih izidih. Vključeni so bili ambulantni in hospitalizirani bolniki s SP. Uporabili smo analize zanesljivosti in veljavnosti, teste razlik med skupinami, modeliranje rasti, Kaplan-Meierjevo metodo in Coxove regresijske modele. Rezultati: TDS-HF in CNAQ sta potrdila enofaktorsko strukturo ter izkazala dobro vsebinsko in kriterijsko veljavnost ter zadovoljivo zanesljivost. V presečni raziskavi s 103 ambulantnimi bolniki sta bila žeja in zmanjšan apetit sočasno prisotna pri slabi tretjini bolnikov ter povezana s spolom, vnosom tekočin, farmakološkim zdravljenjem in simptomi depresije. V prospektivni raziskavi s 56 hospitaliziranimi bolniki sta se žeja in apetit po odpustu različno spreminjala. Spremembe so bile povezane z biokemičnimi kazalci, omejitvijo tekočin in simptomi depresije. Visoka jakost žeje je napovedovala večje tveganje za povečanje diuretika, obisk urgence in hospitalizacijo; pogostejša žeja pa le za povečanje odmerka diuretika. Razprava in zaključek: Slovenski različici TDS-HF in CNAQ imata ustrezne psihometrične lastnosti. Žeja in zmanjšan apetit sta prisotna v vseh fazah bolezni ter pomembno povezana s socialno-demografskimi in kliničnimi dejavniki. Poznavanje le teh prispeva k zgodnejšemu prepoznavanju ogroženih bolnikov. V 24-tedenskem spremljanju po odpustu sta se simptoma različno spreminjala, vendar brez usmerjenega ukrepanja izboljšanja ni pričakovati. Ker oba simptoma vplivata na prognozo, ju je treba redno spremljati. Ciljane intervencije zdravstvene nege za lajšanje žeje in spodbujanje apetita lahko pomembno prispevajo k izboljšanju z zdravjem povezane kakovosti življenja in zmanjšanju tveganja za neugodne klinične izide pri bolnikih s SP.

• Jezik: Slovenski jezik
• Ključne besede: jakost žeje, obremenjenost z žejo, stopnja apetita, tveganje za izgubo telesne mase, razvoj skozi čas
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2025
• PID: 20.500.12556/RUL-175871
• Datum objave v RUL: 12.11.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Impact of thirst and appetite on clinical outcomes in patients with heart failure

Izvleček

Introduction: Thirst and loss of appetite are common but often overlooked symptoms in patients with heart failure (HF). Aim: To examine changes in the dimensions of thirst and appetite, their association with socio-demographic and clinical factors, and their potential impact on clinical outcomes. Methods: We conducted a psychometric evaluation, a cross-sectional epidemiological study, and two prospective observational studies. Data were collected on socio-demographic and clinical characteristics, dimensions of thirst and appetite, anxiety and depression, health-related quality of life, and clinical outcomes. The study included both outpatients and hospitalized patients with HF. We used reliability and validity analyses, group comparison tests, growth modeling, the Kaplan-Meier method, and Cox regression models. Results: The TDS-HF and CNAQ confirmed a one-factor structure and demonstrated good content and criterion validity as well as acceptable reliability. In the cross-sectional study involving 103 outpatients, thirst and reduced appetite co-occurred in approximately one-third of patients and were associated with gender, fluid intake, treatment, and depressive symptoms. In the prospective study involving 56 hospitalized patients, thirst and appetite changed differently after discharge; changes were associated with biochemical markers, fluid restriction, and depressive symptoms. High thirst intensity predicted an increased risk of diuretic dose escalation, emergency department visits, and rehospitalization, while more frequent thirst was associated with a higher likelihood of diuretic dose escalation. Discussion and Conclusion: The Slovenian versions of the TDS-HF and CNAQ are reliable and valid. Thirst and loss of appetite are present across all stages of the disease and are significantly associated with socio-demographic and clinical factors, enabling better identification of high-risk patients. Over 24 weeks of follow-up after discharge, the symptoms evolved differently, but improvement without targeted intervention is unlikely. As both symptoms affect prognosis, they should be regularly monitored. Targeted nursing interventions to relieve thirst and support appetite may significantly improve patients’ health-related quality of life and reduce the risk of adverse clinical outcomes.

• Ključne besede: thirst intensity, thirst distress, appetite level, risk of weight loss, symptom trajectory