The prognostic importance of anemia in patients with heart failure
The prognostic importance of anemia in patients with heart failure
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DOI：
10.1016/s0002-9343(02)01498-5
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发表时间：
2003-02-01
影响因子：
5.9
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Kosiborod, M;Smith, GL;Krumholz, HM
目的：生理学研究表明，贫血可能对心力衰竭患者的心血管状况产生不利影响。然而，流行病学研究还没有很好地确定这种可治疗疾病的预后重要性。我们试图确定红细胞压积水平的预后价值在一个队列中的老年患者住院heartful.METHODS：我们研究了一个连续的样本2281例患者年龄在65岁或以上谁已被承认与主要出院诊断心力衰竭。多变量考克斯比例风险回归进行测试是否红细胞压积水平是一个独立的预测1年死亡率和再入院recommissation.Results：平均（+/- SD）的患者年龄为79 - 8岁，58%（n = 1324）是女性。他们的中位红细胞压积为38%（第25至第75百分位数，33%至42%）。较低的血细胞比容与较高的死亡率相关。在调整人口统计学和临床因素后，红细胞压积每降低1%，1年死亡率就增加2%（P = 0.007）。与红细胞压积> 42%的患者相比，红细胞压积小于或等于27%的患者1年死亡率高40%（风险比[HR] = 1.40; 95%可信区间[CI]：1.02 - 1.92; P = 0.04）。这种增加的风险与传统风险因素所赋予的风险相似，包括左心室射血分数：20%（HR = 1.50; 95% CI：1.20至1.86）。较低的血细胞比容也与更大的再入院风险有关。结论：贫血与老年心力衰竭患者死亡和再住院风险增加有关。贫血是否是导致预后恶化的直接原因，或者是其他因果因素的标志，目前尚不清楚。(C)2003年，Excerpta Medica Inc.
PURPOSE: Physiologic studies have suggested that anemia could adversely affect the cardiovascular condition of patients with heart failure. Yet, the prognostic importance of this treatable condition is not well established by epidemiologic studies. We sought to determine the prognostic value of hematocrit level in a cohort of elderly patients hospitalized with heart failure.METHODS: We studied a consecutive sample of 2281 patients aged 65 years or older who had been admitted with a principal discharge diagnosis of heart failure. Multivariate Cox proportional hazards regression was conducted to test whether hematocrit level was an independent predictor of 1-year mortality and of hospital readmission.RESULTS: The mean (+/- SD) age of the patients was 79 8 years; 58% (n = 1324) were women. Their median hematocrit was 38% (25th to 75th percentile, 33% to 42%). Lower hematocrits were associated with a higher mortality. After adjusting for demographic and clinical factors, each 1% lower hematocrit was associated with a 2% greater 1-year mortality (P = 0.007). Compared with patients with a hematocrit >42%, those with a hematocrit less than or equal to27% had a 40% greater 1-year mortality (hazard ratio [HR] = 1.40; 95% confidence interval [CI]: 1.02 to 1.92; P = 0.04). This increased risk was similar to that conferred by traditional risk factors, including a left ventricular ejection fraction : 20% (HR = 1.50; 95% CI: 1.20 to 1.86). Lower hematocrits were also associated with a greater risk of hospital readmission.CONCLUSION: Anemia is associated with an increased risk of death and rehospitalization in older patients with heart failure. Whether anemia is a direct cause of worse outcomes, or a marker for other causal factors, is not known. (C) 2003 by Excerpta Medica Inc.