Markers of inflammation and mortality in a cohort of patients with alcohol dependence.
Markers of inflammation and mortality in a cohort of patients with alcohol dependence.
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DOI：
10.1097/md.0000000000000607
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发表时间：
2015-03
期刊：
影响因子：
1.6
通讯作者：
Muga R
中科院分区：
文献类型：
--
作者：
Fuster D;Sanvisens A;Bolao F;Zuluaga P;Rivas I;Tor J;Muga R
炎症和肠道通透性被认为是酒精相关肝损伤发展的最重要特征。我们的目的是评估3种炎症替代标志物（贫血、纤维蛋白原和铁蛋白水平）对酒精依赖患者中期死亡率的影响。这项纵向研究包括2000年至2010年期间住院戒毒的酒精依赖患者。根据临床图表和死亡登记册确定死亡率。用死亡率和考克斯比例风险回归模型分析炎症标志物与全因死亡率之间的关系。我们还根据贫血患者的平均红细胞体积（MCV）对贫血患者的死亡率进行了亚组分析。我们纳入了909例酒精依赖患者。患者大多为男性（80.3%），中位年龄为44岁（四分位距[IQR]：38-50），入院时，他们的中位饮酒量为192 g/天（IQR：120-265）。 入院时，182例（20.5%）患者贫血; 210例（25.9%）纤维蛋白原水平>4.5 mg/dL; 365例（49.5%）铁蛋白水平>200 ng/mL。 在随访结束时（中位3.8年[IQR：1.8-6.5]，总计3861.07人-年），118例患者死亡（占研究人群的12.9%）。考克斯回归模型显示，基线贫血与死亡率相关（风险比[HR]：1.67，95%置信区间[CI]：1.11-2.52，P <0.01）;未发现死亡率与高纤维蛋白原或高铁蛋白水平之间存在相关性。 对贫血患者亚组进行分析，并与无贫血且MCV正常的对照组患者进行比较。正常红细胞和大红细胞贫血患者的死亡率分别为3.25（95% CI：1.41-7.26; P <0.01）和3.39（95% CI：1.86-6.43; P <0.01）。 因酒精依赖入院戒毒的患者在入院时存在贫血时死亡风险增加。需要更准确的全身性炎症标志物作为该亚组患者不良结局的预后因素。
Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38–50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120–265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels >4.5 mg/dL; and 365 (49.5%) had ferritin levels >200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8–6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11–2.52, P < 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41–7.26; P < 0.01) and 3.39 (95% CI: 1.86–6.43; P < 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patients.