What constitutes normal hemoglobin concentration in community-dwelling disabled older women?
What constitutes normal hemoglobin concentration in community-dwelling disabled older women?
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DOI：
10.1111/j.1532-5415.2004.52502.x
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发表时间：
2004-11-01
影响因子：
6.3
通讯作者：
Fried, LP
中科院分区：
文献类型：
--
作者：
Chaves, PHM;Xue, QL;Fried, LP
目的：研究血红蛋白（Hb）浓度与(1)5年全因死亡率和(2)血清促红细胞生成素（EPO）之间的关系，作为确定数据驱动阈值的基础，并评估轻度低Hb的临床相关性。设计：前瞻性研究。设置：基于人口。参与者：社区居住的65岁及以上有中度至重度残疾的妇女——妇女健康与老龄化研究I，巴尔的摩，1992-2000。方法：采用比例风险回归对基线Hb（686例受试者）与死亡时间之间的关系进行建模。采用广义线性模型评估641名受试者Hb和EPO之间的横断面关联。结果：在Hb阈值13.9 g/dL之前，观察到死亡率稳定下降的曲线斜率。在综合调整主要健康状况和疾病负担指标后，11 g/dL的Hb与世界卫生组织（WHO） 12 g/dL的低正常临界值(风险比（HR)=1.2, 95%可信区间(CI)=1.1-1.4）相比，与更高的死亡率独立相关（HR=0.76, 95% CI=0.63-0.92），而14 g/dL的Hb与低24%的死亡率相关（HR=0.76, 95% CI=0.63-0.92）。随着血红蛋白的增加，EPO的稳定下降呈统计学上显著的曲线斜率，直至阈值为14.3 g/dL。结论：高Hb水平显著降低的死亡风险提供了经验证据，反对目前认为的轻度低Hb是临床良性的观点。此外，即使在世界卫生组织正常血红蛋白范围内观察到的死亡风险梯度表明，高于目前推荐的血红蛋白水平可能会提供临床优势。血红蛋白和促生成素之间的关系为这一假设提供了支持的生理学证据。
Objectives: To examine the associations between hemoglobin (Hb) concentration and (1) 5-year all-cause mortality and (2) serum erythropoietin (EPO), as the basis for the identification of data-driven thresholds, and to assess the clinical relevance of mildly low Hb.Design: Prospective study.Setting: Population based.Participants: Community-dwelling women aged 65 and older with moderate-to-severe disability-Women's Health and Aging Study I, Baltimore, Maryland, 1992-2000.Methods: Proportional hazards regression was used to model the relationship between baseline Hb (available for 686 subjects) and time to death. A generalized linear model was used to assess the cross-sectional association between Hb and EPO in 641 subjects.Results: A curvilinear slope of steady mortality decrease up to the Hb threshold of 13.9 g/dL was observed. Hb of 11 g/dL was independently associated with greater mortality than the World Health Organization (WHO) low-normal cutoff of Hb of 12 g/dL (hazard ratio (HR)=1.2, 95% confidence interval (CI)=1.1-1.4), whereas Hb of 14 g/dL was linked to 24% lower mortality (HR=0.76, 95% CI=0.63-0.92), after comprehensive adjustment for major health status and disease-burden indicators. A curvilinear, statistically significant slope of steady EPO decrease with increasing Hb up to the threshold of 14.3 g/dL was consistently observed.Conclusion: The meaningfully lower mortality risk with higher Hb levels provides empirical evidence against the notion that Hb currently perceived as mildly low is clinically benign. Furthermore, the mortality risk gradient observed even within the WHO normal Hb range suggests that Hb levels higher than what is currently recommended might offer clinical advantage. The relationship between Hb and EPO provided supporting physiological evidence for this hypothesis.