Anemia predicts mortality in severe heart failure - The prospective randomized amlodipine survival evaluation (PRAISE)
Anemia predicts mortality in severe heart failure - The prospective randomized amlodipine survival evaluation (PRAISE)
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DOI：
10.1016/s0735-1097(03)00425-x
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发表时间：
2003-06-04
影响因子：
24
通讯作者：
Levy, WC
中科院分区：
文献类型：
--
作者：
Mozaffarian, D;Nye, R;Levy, WC
我们的目的是研究血清红细胞压积（Hct）与严重心力衰竭（HF）患者全因死亡率风险之间的关系。然而，很少有研究探讨贫血对死亡率的影响，在此population.METHODS采用前瞻性队列设计，我们评估了基线血清红细胞压积和死亡率之间的关系，1,130例左心室EF < 30%和纽约心脏协会功能分类11113或IV HF治疗血管紧张素转换酶抑制剂，利尿剂，洋地黄。结果平均Hct为41.8%（范围25.4%~ 58.8%）。平均随访15个月以上，有407例死亡（每100人年29例）。校正潜在混杂因素后，与最高五分位数（范围46.1%至58.8%）相比，Hct最低五分位数（范围25.4%至37.5%）的死亡风险高52%（风险比1.52，95%置信区间1.11至2.10）。在Hct最低的五分位数中，Hct每降低1%，死亡风险就增加11%（p < 0.01），而在Hct较高的四个五分位数中，Hct与总死亡率无关。不同的死亡原因的评估表明，较低的红细胞压积与进展性心力衰竭的死亡密切相关，而不是猝死或其他deaths.CONCLUSIONS在重度心力衰竭患者中，贫血是一个重要的独立死亡危险因素，随着贫血严重程度的增加，其风险逐渐升高。对严重HF患者贫血的病因、预防和治疗进行进一步研究是必要的。(C)2003年由美国心脏病学会基金会。
OBJECTIVES Our aim was to examine the relationships between serum hematocrit (Hct) and risk of all-cause mortality among patients with severe heart failure (HF).BACKGROUND Anemia occurs with increased frequency in severe HF. However, few studies have examined the impact of anemia on mortality in this population.METHODS Using a prospective cohort design, we evaluated the relationships between baseline serum Hct and mortality among 1,130 patients with left ventricular EF < 30% and New York Heart Association functional class 11113 or IV HF treated with angiotensin-converting enzyme inhibitors, diuretics, and digitalis. Mortality was ascertained by centralized adjudication.RESULTS The mean Hct was 41.8% (range 25.4% to 58.8%). Over 15 months of mean follow-up, there were 407 deaths (29 per 100 person-years). After adjustment for potential confounders, those in the lowest quintile of Hct (range 25.4% to 37.5%) had a 52% higher risk of death (hazard ratio 1.52, 95% confidence interval 1.11 to 2.10), compared with the highest quintile (range 46.1% to 58.8%). Within the lowest quintile of Hct, each 1% decrease in Hct was associated with an 11% higher risk of death (p < 0.01), whereas within the four higher quintiles of Hct, Hct was not associated with total mortality. Evaluation of different causes of death indicated that a lower Hct was strongly associated with death from progressive HF, rather than sudden death or other deaths.CONCLUSIONS Among patients with severe HF, anemia is a significant independent risk factor for death, with a progressively higher risk with increasing severity of anemia. Further investigation of the etiologies, prevention, and treatment of anemia in severe HF is warranted. (C) 2003 by the American College of Cardiology Foundation.