Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease.
Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease.
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DOI：
10.1016/j.amjcard.2010.12.023
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发表时间：
2011-04-15
影响因子：
2.8
通讯作者：
Kullo, Iftikhar J.
中科院分区：
文献类型：
--
作者：
Ye, Zi;Smith, Carin;Kullo, Iftikhar J.
红细胞分布宽度（RDW）增加是红细胞大小不均的标志，在多种情况下与不良后果相关。 RDW 是否可以预测外周动脉疾病 (PAD) 患者的死亡率尚不清楚。我们研究了 1/97 至 12/07 期间在梅奥诊所通过无创下肢动脉检测确定患有 PAD 的 13,039 名连续门诊患者（年龄 69.5 ±12.0 岁，60.9% 男性，97.6% 白人），并随访至 9/09。我们将 PAD 定义为低（≤0.9）或高（≥1.4）踝臂指数（ABI）。使用基于电子病历（EMR）的算法确定心血管危险因素和合并症。 RDW 是从动脉评估时采集的全血细胞计数获得的。使用 Mayo EMR 和 Accurint® 数据库确定死亡率。通过多变量 Cox 比例风险回归分析 RDW 与全因死亡率的关联。在中位随访 5.5 年期间，发生了 4039 例 (31.0%) 死亡（低 ABI 子集为 28.7%，高 ABI 子集为 38.9%）。调整年龄、性别、心血管危险因素和合并症后，RDW 最高四分位数 (>14.5%) 的患者的死亡风险比最低四分位数 (<12.8%) 的患者高 66% (P<0.0001)； RDW 增加 1% 与全因死亡风险增加 10% 相关（风险比为 1.10，95% 置信区间 [CI]，1.08 至 1.12，P<0.0001）。调整后的风险比在低 (1.10, 1.08-1.12) 和高 (1.09, 1.06-1.12) ABI 子集中相似。总之，RDW 作为一种常规可用的测量方法，是 PAD 患者的独立预后标志物。
Increased red cell distribution width (RDW), a marker of anisocytosis, has been associated with adverse outcomes in multiple settings. Whether RDW is predictive of mortality in patients with peripheral artery disease (PAD) is unknown. We studied 13,039 consecutive outpatients (age 69.5 ±12.0 years, 60.9% men, 97.6% white) with PAD identified by non-invasive lower-extremity arterial testing at Mayo Clinic from 1/97 to 12/07, with follow-up through 9/09. We defined PAD as low (≤0.9) or high (≥1.4) ankle-brachial index (ABI). Cardiovascular risk factors and comorbidities were ascertained using electronic medical record (EMR)-based algorithms. RDW was obtained from the complete blood count drawn around the time of arterial evaluation. Mortality was ascertained using the Mayo EMR and Accurint® database. The association of RDW with all-cause mortality was analyzed by multivariable Cox proportional hazards regression. During a median follow-up of 5.5 years, 4039 (31.0 %) deaths occurred (28.7% in low and 38.9% in high ABI subsets). After adjustment for age, sex, cardiovascular risk factors and comorbidities, patients in the highest quartile of RDW (>14.5%) had 66% greater risk of mortality compared to the lowest quartile (<12.8%) (P<0.0001); a 1% increment in RDW was associated with 10% greater risk of all-cause mortality (hazard ratio, 1.10, 95% confidence interval [CI], 1.08 to 1.12, P<0.0001). The adjusted hazard ratio was similar in the low (1.10, 1.08-1.12) and high (1.09, 1.06-1.12) ABI subsets. In conclusion, RDW, a routinely available measure, is an independent prognostic marker in patients with PAD.
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