Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis.
Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis.
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DOI：
10.14740/cr732w
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发表时间：
2018-06
影响因子：
1.9
通讯作者：
Punzalan FER
中科院分区：
文献类型：
--
作者：
Abrahan LL 4th;Ramos JDA;Cunanan EL;Tiongson MDA;Punzalan FER
红细胞分布宽度(RDW)是全血细胞计数(CBC)的常规组成部分，用于测量循环中红细胞大小的变化。它与心血管疾病的几种临床结局有关。我们试图通过汇集现有研究的数据来加强RDW与急性冠脉综合征(ACS)住院患者死亡率之间的关联。符合以下条件的研究被确定用于分析：1)观察性的；2)入院的急性冠脉综合征患者；3)报告的与RDW低或高相关的全原因或心血管(CV)死亡率的数据；以及4)使用Logistic回归分析控制混杂因素。使用MEDLINE、临床关键字、Science Direct、Scope us和Cochrane Central Register of Control Trials数据库，对符合条件的研究进行搜索，直到2017年1月9日。使用纽卡斯尔-渥太华质量评估量表对每项研究的质量进行评估。我们感兴趣的主要结果是全因或心血管死亡。在报道这些结果的研究中，我们还调查了RDW对主要不良心血管事件(MACE)的影响。用Review Manager(Revman)5.3进行随机效应的Mantel-Haenzel分析和相对危险度计算。我们确定了涉及10,410名患者的13项试验，表明在急性冠脉综合征患者中，低RDW与统计上显著的全原因或心血管死亡率(RR0.35，(95%可信区间0.30至0.40)，P<；0.00001，I2=53%)相关，这一发现在短期和长期都是一致的。低RDW也与急性冠脉综合征后急性冠脉综合征的风险降低相关(RR0.56RR0.51to0.61P<；0.00001，I2=91%)。在急性冠脉综合征期间，较低的RDW与较低的全因或心血管死亡率以及随后发生急性冠脉综合征的风险较低相关，这为我们提供了一种方便且廉价的急性冠脉综合征患者风险分层工具。
Red cell distribution width (RDW), a routine component of the complete blood count (CBC), measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular disease. We sought to strengthen the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) by pooling together data from available studies. Studies that fulfilled the following were identified for analysis: 1) observational; 2) included patients admitted for ACS; 3) reported data on all-cause or cardiovascular (CV) mortality in association with a low or high RDW; and 4) used logistic regression analysis to control for confounders. Using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until January 9, 2017. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Our primary outcome of interest was all-cause or CV mortality. We also investigated the impact of RDW on major adverse cardiovascular events (MACEs) for the studies that reported these outcomes. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk. We identified 13 trials involving 10,410 patients, showing that in ACS, a low RDW is associated with a statistically significant lower all-cause or CV mortality (RR 0.35, (95% CI 0.30 to 0.40), P < 0.00001, I2 = 53%), a finding that was consistent both in the short- and long-term. A low RDW is also associated with lower risk for MACEs after an ACS (RR 0.56, (95% CI 0.51 to 0.61), P < 0.00001, I2 = 91%). A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.